老年乳腺癌患者的综合治疗方式选择及其影响因素分析  

Comprehensive treatment options and influencing factors in elderly patients with breast cancer

作　　者：林燕[1] 徐颖[1] 曹希[1] 周星彤 周易冬[1] 茅枫[1] 王常珺[1] 徐雅莉[1] 孙强[1] Lin Yan;Xu Ying;Cao Xi;Zhou Xingtong;Zhou Yidong;Mao Feng;Wang Changjun;Xu Yali;Sun Qiang(Department of Breast Surgery,Peking Union Medical College(PUMC)Hospital,Chinese Academy of Medical Sciences and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院乳腺外科,北京100730

出　　处：《中华医学杂志》2022年第6期428-434,共7页National Medical Journal of China

摘　　要：目的探讨65岁及以上老年乳腺癌患者治疗方式选择并综合分析其影响因素。方法收集2009年1月至2015年12月在北京协和医院手术治疗的521例年龄≥65岁的老年乳腺癌患者的临床资料,全部为女性,年龄65~98岁。按照年龄分为65~74岁组(n=353)和≥75岁组(n=168)。比较两组间包括患者年龄、功能状况、治疗方式、病理特点、合并症和生存时间等变量的差异。并分析其综合治疗方式的差异及其对临床疗效的影响。结果两组患者手术方式主要为改良根治术[分别为39.1%(138/353)和33.9%(57/168)]、保乳手术[(分别为56.9%(201/353)和61.3%(103/168)]。术后选择辅助治疗的患者中,除化疗外两组间差异均无统计学意义(均P>0.05)。单因素分析显示,化疗的选择与年龄、手术方式、病理类型、肿瘤负荷、分子分型、功能状况以及合并症有关(均P<0.05)。美国东部肿瘤协作组(ECOG)评分和合并症数量是影响老年乳腺癌化疗选择的独立影响因素[ECOG评分:调整后OR=0.45(95CI:0.26~0.75),合并症数量:调整后OR=0.63(95CI:0.41~0.98);均P<0.05]。521例老年乳腺癌患者的5年无病生存率为86.3%,5年总生存率为88.8%,乳腺癌特异性生存率为94.3%。结论≥65岁老年乳腺癌患者的综合治疗方式不受年龄影响,但与肿瘤负荷、病理类型、分子分型、合并症及ECOG评分相关。其中,ECOG评分和合并症数量是影响术后辅助化疗选择的独立影响因素。Objective To investigate the treatment options for breast cancer patients aged 65 and over,and analyze the influencing factors.Methods The clinical data of 521 elderly patients aged 65 years or older,who underwent surgery in Peking Union Medical College Hospital from January 2009 to December 2015,were collected.They were all female and 65-98 years old.The patients were divided into 65-74 years old group(n=353)and≥75 years old group(n=168).The differences of variables including age,functional status,treatment methods,pathological characteristics,comorbidities and survival time between the two groups were compared,and the differences of comprehensive treatment methods and their impact on clinical efficacy were analyzed.Results The main operation methods of the two groups were modified radical mastectomy[39.1%(138/353)and 33.9%(57/168),respectively],breast conserving surgery[56.9%(201/353)and 61.3%(103/353),respectively].Among the patients choosing adjuvant therapy,there was no significant difference between the two groups except chemotherapy(all P>0.05).Univariate analysis showed that the choice of chemotherapy was related to age,surgical methods,pathological types,tumor burden,molecular typing,functional status and comorbidities(all P<0.05).The Eastern Cooperative Oncology Group(ECOG)score and the number of comorbidities were independent factors affecting the choice of chemotherapy for breast cancer in the elderly:[ECOG score:adjusted OR=0.45(95CI:0.26-0.75),number of comorbidities:adjusted OR=0.63(95CI:0.41-0.98);all P<0.05].The 5-year disease-free survival rate of 521 elderly patients with breast cancer was 86.3%,5-year overall survival rate was 88.8%,and the breast cancer specific survival rate was 94.3%.Conclusions The comprehensive treatment of breast cancer patients aged 65 and above is not affected by age,but is associated with tumor burden,pathological type,molecular typing,comorbidities and ECOG score.Among them,ECOG score and the number of comorbidities are the independent factors influencing the choic

关 键 词：老年 乳腺肿瘤 综合治疗 因素分析 

分 类 号：R737.9[医药卫生—肿瘤]