Abstract：
BACKGROUND: As the benefits of intensive locoregional therapy for ductal carcinoma in situ (DCIS) are realized over time in older adults, life expectancy may help to guide treatment decisions. We examined whether life expectancy was associated with extent of locoregional therapy in this population.
METHODS: Women ≥ 70 years old with < 5 cm of DCIS diagnosed 2010-2015 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset and categorized by a life expectancy ≤ 5 or > 5 years, defined by a validated claims-based measure. Differences in locoregional therapy (mastectomy + axillary surgery, mastectomy-only, lumpectomy + radiation therapy (RT) + axillary surgery, lumpectomy + RT, lumpectomy-only, and no treatment) by life expectancy were assessed using Pearson chi-squared tests. Generalized linear mixed models were used to identify factors associated with receipt of lumpectomy-only.
RESULTS: Of 5346 women (median age of 75 years, range 70-97 years), 927 (17.3%) had a life expectancy ≤ 5 years. Of the 4041 patients who underwent lumpectomy, 710 (13.3%) underwent axillary surgery. More patients with life expectancy ≤ 5 years underwent lumpectomy-only (39.4% versus 27%), mastectomy-only (8.1% versus 5.3%), or no treatment (5.8% versus 3.2%; p < 0.001). On multivariable analysis, women with life expectancy ≤ 5 years had a significantly greater likelihood of undergoing lumpectomy-only [OR 1.90, 95% CI (1.63-2.22)].
CONCLUSIONS: Life expectancy is associated with lower-intensity locoregional therapy for older women with DCIS, yet a large proportion of patients with a life expectancy ≤ 5 years received RT and axillary surgery, highlighting potential overtreatment and opportunities to de-escalate locoregional therapy in older adults.
METHODS: Women ≥ 70 years old with < 5 cm of DCIS diagnosed 2010-2015 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset and categorized by a life expectancy ≤ 5 or > 5 years, defined by a validated claims-based measure. Differences in locoregional therapy (mastectomy + axillary surgery, mastectomy-only, lumpectomy + radiation therapy (RT) + axillary surgery, lumpectomy + RT, lumpectomy-only, and no treatment) by life expectancy were assessed using Pearson chi-squared tests. Generalized linear mixed models were used to identify factors associated with receipt of lumpectomy-only.
RESULTS: Of 5346 women (median age of 75 years, range 70-97 years), 927 (17.3%) had a life expectancy ≤ 5 years. Of the 4041 patients who underwent lumpectomy, 710 (13.3%) underwent axillary surgery. More patients with life expectancy ≤ 5 years underwent lumpectomy-only (39.4% versus 27%), mastectomy-only (8.1% versus 5.3%), or no treatment (5.8% versus 3.2%; p < 0.001). On multivariable analysis, women with life expectancy ≤ 5 years had a significantly greater likelihood of undergoing lumpectomy-only [OR 1.90, 95% CI (1.63-2.22)].
CONCLUSIONS: Life expectancy is associated with lower-intensity locoregional therapy for older women with DCIS, yet a large proportion of patients with a life expectancy ≤ 5 years received RT and axillary surgery, highlighting potential overtreatment and opportunities to de-escalate locoregional therapy in older adults.
摘要：
背景：随着时间的推移，在老年人中实现了对导管原位癌（DCIS）的强化局部治疗的益处，预期寿命可能有助于指导治疗决策。我们检查了该人群的预期寿命是否与局部治疗程度相关。
方法：在监测中确定了2010-2015年诊断为DCIS<5cm的≥70岁女性，流行病学,和最终结果(SEER)-医疗保险数据集，按预期寿命≤5年或>5年分类，由经过验证的基于索赔的措施定义。局部治疗的差异（乳房切除术+腋窝手术，只做乳房切除术,肿块切除术+放射治疗（RT）+腋窝手术，肿块切除术+RT,仅乳房肿瘤切除术,使用Pearson卡方检验评估预期寿命）。使用广义线性混合模型来识别与仅接受乳房肿瘤切除术相关的因素。
结果：5346名妇女（平均年龄75岁，范围70-97年)，927（17.3％）的预期寿命≤5年。在4041例接受乳房肿瘤切除术的患者中,710例（13.3%）接受了腋窝手术。更多预期寿命≤5年的患者仅接受乳房肿瘤切除术（39.4%对27%），仅乳房切除术(8.1%对5.3%)，或不治疗（5.8%对3.2%；p<0.001）。在多变量分析中，预期寿命≤5岁的女性仅接受乳房肿瘤切除术的可能性显著增加[OR1.90,95%CI(1.63~2.22)].
结论：老年DCIS患者的预期寿命与低强度局部区域治疗有关，然而，大部分预期寿命≤5年的患者接受了RT和腋窝手术，强调潜在的过度治疗和降低老年人局部治疗的机会。
方法：在监测中确定了2010-2015年诊断为DCIS<5cm的≥70岁女性，流行病学,和最终结果(SEER)-医疗保险数据集，按预期寿命≤5年或>5年分类，由经过验证的基于索赔的措施定义。局部治疗的差异（乳房切除术+腋窝手术，只做乳房切除术,肿块切除术+放射治疗（RT）+腋窝手术，肿块切除术+RT,仅乳房肿瘤切除术,使用Pearson卡方检验评估预期寿命）。使用广义线性混合模型来识别与仅接受乳房肿瘤切除术相关的因素。
结果：5346名妇女（平均年龄75岁，范围70-97年)，927（17.3％）的预期寿命≤5年。在4041例接受乳房肿瘤切除术的患者中,710例（13.3%）接受了腋窝手术。更多预期寿命≤5年的患者仅接受乳房肿瘤切除术（39.4%对27%），仅乳房切除术(8.1%对5.3%)，或不治疗（5.8%对3.2%；p<0.001）。在多变量分析中，预期寿命≤5岁的女性仅接受乳房肿瘤切除术的可能性显著增加[OR1.90,95%CI(1.63~2.22)].
结论：老年DCIS患者的预期寿命与低强度局部区域治疗有关，然而，大部分预期寿命≤5年的患者接受了RT和腋窝手术，强调潜在的过度治疗和降低老年人局部治疗的机会。
