老年乳腺癌术后内分泌治疗能否获益
对于伴有多种合并症的老年乳腺癌患者，术后内分泌治疗获益数据较少。
2021年3月18日，美国癌症学会《癌症》在线发表德克萨斯大学MD安德森癌症中心的研究报告，探讨了术后内分泌治疗对老年伴有多种合并症、雌激素受体阳性、HER2阴性、病理淋巴结阴性乳腺癌患者生存结局的影响。
该研究利用美国外科医师学会（ACS）全国癌症数据库（NCDB）对2010～2014年的数据进行回顾分析，将年龄≥70岁、卡德合并症评分为2或3、病理肿瘤分期为T1～T3、病理淋巴结阴性、雌激素受体阳性、HER2阴性乳腺癌术后女性分为两组：接受内分泌治疗组2705例、放弃内分泌治疗组1011例，分别占72.8%、27.2%。由于两组患者比例和特征分布悬殊，故通过倾向评分，对年龄、合并症评分、医院类型、病理肿瘤分期、化疗、手术、放疗对两组患者进行配对后，两组各986例。通过多因素比例风险回归模型，对诊断年份、年龄、合并症、医院类型、病理分期、分级、化疗、切缘状态、局部区域治疗等其他影响因素进行校正后，推算内分泌治疗对总生存的影响。
配对前，2705例接受内分泌治疗与1011例放弃内分泌治疗的患者相比：
年龄较小（平均年龄：76比79岁，P<0.001）
保乳较多（乳房肿块切除术＋放疗：43.4%比23.8%，P<0.001）
配对后，986例接受内分泌治疗与986例放弃内分泌治疗的患者相比：
总生存时间显著较长（中位79.2比67.7个月，P<0.0001）
总死亡风险显著较低（校正后风险比：0.70，95%置信区间：0.59～0.83）
因此，该研究结果表明，对于伴有老年多种合并症的病理淋巴结阴性、雌激素受体阳性、HER2阴性乳腺癌患者，术后内分泌治疗可改善总生存。不过，由于观察研究难以避免的混杂因素，总生存可能高估。为了改善此类患者的生存结局，应根据预计寿命和治疗耐受程度并按不同分期考虑现有指南标准推荐意见。
Cancer. 2021 Mar 18. Online ahead of print.
Impact of adjuvant endocrine therapy in older patients with comorbidities and estrogen receptor-positive, node-negative breast cancer-a National Cancer Database analysis.
Tamirisa N, Lin H, Shen Y, Shaitelman SF, Karuturi MS, Giordano SH, Babiera GV, Bedrosian I.
The University of Texas MD Anderson Cancer Center, Houston, Texas.
In older patients with multiple comorbidities and estrogen receptor-positive/human epidermal growth factor receptor 2-negative, pathologic node-negative breast cancer, adjuvant endocrine therapy is associated with improved survival. To optimize outcomes in these patients, current standard recommendations should be considered stage-for-stage based on life expectancy and level of tolerance to treatment.
BACKGROUND: Data are lacking about the benefit of adjuvant endocrine therapy (ET) in older patients with multiple comorbidities. The authors sought to determine the effect of ET on the survival of older patients who had multiple comorbidities and estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, pathologic node-negative (pN0) breast cancer.
METHODS: Women aged ≥70 years in the National Cancer Database (2010-2014) with Charlson/Deyo comorbidity scores of 2 or 3 who had pathologic tumor (pT1)-pT3/pN0, ER-positive/HER2-negative breast cancer were divided into 2 cohorts: adjuvant ET and no ET. Propensity scores were used to match patients based on age, comorbidity score, facility type, pT classification, chemotherapy, surgery, and radiation therapy. A Cox proportional hazards model was used to estimate the effect of ET on overall survival (OS).
RESULTS: In the nonmatched cohort (n = 3716), 72.8% of patients received ET (n = 2705), and 27.2% did not (n = 1011). The patients who received ET were younger (mean age, 76 vs 79 years; P < .001) and had higher rates of breast conservation compared with those who did not receive ET (lumpectomy plus radiation: 43.4% vs 23.8%, respectively; P < .001). In the matched cohort (n = 1972), the median OS was higher in the ET group (79.2 vs 67.7 months; P < .0001). In the adjusted analysis, ET was associated with improved survival (hazard ratio, 0.70; 95% CI, 0.59-0.83).
CONCLUSIONS: In older patients who have pN0, ER-positive/HER2-negative breast cancer with comorbidities, adjuvant ET was associated with improved OS, which may have been overestimated given the confounders inherent in observational studies. To optimize outcomes in these patients, current standard recommendations should be considered stage-for-stage based on life expectancy and the level of tolerance to treatment.
KEYWORDS: adjuvant; breast cancer; endocrine therapy; older
PMID: 33735487
DOI: 10.1002/cncr.33489