METHODS: This single-institution retrospective cohort study analyzed patients aged ≥90 years diagnosed with stage I-III BC between 2007 and 2018. Patients were categorized into three treatment groups: traditional surgery (TS), performed according to local guidelines; current-standard surgery (CS), defined as breast surgery without axillary surgery (in concordance with 2016 Choosing Wisely guidelines) and/or cavity shaving; and non-surgical treatment (NS). Clinicopathological features were recorded and recurrence rates and survival outcomes were analyzed.
RESULTS: We collected data from 113 nonagenarians with a median age of 93 years (range 90-99). Among these patients, 43/113 (38.1%) underwent TS, 34/113 (30.1%) underwent CS, and 36/113 (31.9%) underwent NS. The overall recurrence rate among surgical patients was 10.4%, while the disease progression rate in the NS group was 22.2%. Overall survival was significantly longer in surgical patients compared with NS patients (p = 0.04). BC-related mortality was significantly higher in the NS group than in the TS and CS groups (25.0% vs. 0% vs. 7.1%, respectively; p = 0.01). There were no significant differences in overall survival and disease-free survival between the TS and CS groups (p = 0.6 and p = 0.8, respectively), although the TS group experienced a significantly higher overall postoperative complication rate (p < 0.001).
CONCLUSIONS: Individualized treatment planning is essential for nonagenarian BC patients. Surgery, whenever feasible, remains the treatment of choice, with CS emerging as the best option for the majority of patients.
方法:这项单机构回顾性队列研究分析了2007年至2018年间诊断为I-III期BC的年龄≥90岁的患者。患者分为三个治疗组:传统手术(TS),根据当地指南进行;现行标准手术(CS),定义为不进行腋窝手术的乳房手术(与2016年选择明智指南一致)和/或腔剃;和非手术治疗(NS)。记录临床病理特征,分析复发率和生存结果。
结果:我们收集了113名平均年龄为93岁(90-99岁)的非成年患者的数据。在这些患者中,43/113(38.1%)接受TS,34/113(30.1%)接受CS,36/113(31.9%)接受NS。手术患者的总复发率为10.4%,而NS组的疾病进展率为22.2%。与NS患者相比,手术患者的总生存期明显更长(p=0.04)。NS组的BC相关死亡率明显高于TS和CS组(25.0%vs.0%vs.7.1%,分别为;p=0.01)。TS组和CS组之间的总生存期和无病生存期没有显着差异(分别为p=0.6和p=0.8),尽管TS组术后总并发症发生率明显较高(p<0.001)。
结论:个体化的治疗计划对于非未成熟的BC患者至关重要。手术,只要可行,仍然是选择的治疗方法,CS成为大多数患者的最佳选择。