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.
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。