老年与非老年女性乳腺癌患者临床病理特征和影响预后因素的差异分析  

Analysis of differences in clinicopathological characteristics and prognostic factors between elderly and non-elderly female breast cancer patients

作　　者：范蕾 黄纪程 李尧[1] 华彬[1] Fan Lei;Huang Jicheng;Li Yao;Hua Bin(Breast center,Department of Thyroid-breast-hernia Surgery,Department of General Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院普通外科甲状腺乳腺疝外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第9期1162-1173,共12页Chinese Journal of Geriatrics

基　　金：中央高水平医院临床科研业务费(BJ-2019-191)。

摘　　要：目的通过与非老年患者对比,分析老年女性乳腺癌患者的临床病理特征,探讨影响老年女性乳腺癌患者预后的因素。方法收集美国国家癌症研究所监测、流行病学和最终结果(SEER)数据库中1975—2015年共86064例女性乳腺癌患者信息,将65岁及以上的患者分为老年组,65岁以下的患者分为非老年组。通过卡方检验分析两组患者的基线资料和临床病理特征的差异,通过Kaplan-Meier法绘制老年组和非老年组总生存(OS)和乳腺癌特异性生存(BCSS)曲线,通过单因素和多因素Cox回归分析影响老年乳腺癌患者OS和BCSS的因素。结果与非老年组相比,老年组乳腺癌患者中白种人、丧偶、居住在非大都市的人口更多,家庭中位年收入更低,组织学分级更低,临床分期更早,雌激素(ER)和孕激素(PR)受体阳性占比更高,人类表皮生长因子受体2(HER2)阳性比例更低,选择标准治疗的人更少(均P<0.001)。相较非老年组,老年组患者的预后更差,全因死亡风险和乳腺癌特异死亡风险更高(P<0.001)。多因素分析显示接受标准治疗对老年患者OS和BCSS均为保护因素。结论本组老年乳腺癌患者具有临床分期早,组织学分级低,ER、PR阳性比例高,HER2阳性比例低的特点。OS和BCSS均显著差于非老年组患者,分析显示治疗不及时不标准是重要的影响因素,需临床医生给予关注。ObjectiveComparison with non-elderly patients to analyze the clinicopathological characteristics of elderly female breast cancer(BC)patients and to explore the factors influencing their prognosis.MethodsData were collected from 86,064 female BC patients in the National Cancer Institute's Surveillance,Epidemiology,and End Results(SEER)database,spanning from 1975 to 2015.Patients aged 65 and older were classified as the elderly group,while those under 65 were designated as the non-elderly group.The baseline characteristics and clinicopathological differences between the two groups were analyzed using the chi-square test.The Kaplan-Meier method was employed to plot overall survival(OS)and breast cancer-specific survival(BCSS)curves for both groups.Additionally,factors influencing OS and BCSS in elderly BC patients were examined through univariate and multivariate Cox regression analyses.ResultsIn comparison to the non-elderly group,elderly BC patients exhibited a higher proportion of white individuals,widows,residents from non-metropolitan areas,lower median household income,lower histological grade,and earlier clinical stage.Furthermore,this group demonstrated a greater prevalence of estrogen receptor(ER)and progesterone receptor(PR)positivity,a lower prevalence of human epidermal growth factor receptor 2(HER2)positivity,and fewer individuals received standard treatment(all P<0.001).The prognosis for the elderly group was poorer,characterized by increased risks of all-cause mortality and breast cancer-specific mortality(P<0.001).Multivariate analysis revealed that receiving standard treatment served as a protective factor for both OS and BCSS in elderly patients.ConclusionsIn this cohort,elderly breast cancer patients were characterized by an earlier clinical stage,lower histological grade,higher rates of ER and PR positivity,and a lower rate of HER2 positivity.Their OS and BCSS rates were significantly worse than those of the non-elderly group.The analysis indicates that inadequate and non-standard treatment is a

关 键 词：乳腺肿瘤 SEER 预后 

分 类 号：R737.9[医药卫生—肿瘤]