背景:尽管老年三阴性乳腺癌(TNBC)患者的化疗使用率较低,他们的结果与年轻的同行相匹配。我们比较了在主要癌症中心接受化疗的早期TNBC患者的年龄与国家TNBC数据库的结果。
方法:使用I-III期TNBC(ER/PR<10%)患者新辅助/辅助化疗的机构数据进行回顾性研究。根据他们诊断时的年龄,患者分为4类:≤40岁,41-59岁,60-69岁和≥70岁.记录的人口统计学和临床特征包括种族,疾病阶段,ER/PR阳性,治疗方案,淋巴或血管浸润(LVI),组织学分级,Ki-67级,体重指数(BMI),和新辅助治疗后的病理完全缓解(pCR),并使用描述性统计进行总结。主要终点是总生存期(OS),无病生存率(DFS),和远处无病生存率(DDFS);所有这些都是使用Kaplan-Meier方法估计的。应用单变量和多变量(MV)Cox回归来评估重要协变量对这些时间至事件终点的影响。
结果:在研究的2336例患者中,492人(21.1%)≤40岁,1239(53.1%)为41-59,461(19.7%)为60-69,144(6.2%)为≥70。在OS/DFS/DDFS的单变量回归模型中,年龄≥70岁与OS差显著相关(p=0.0217);与OS差相关的其他因素是非蒽环类化疗,肿瘤分期较高,和新辅助化疗。多元Cox回归模型,适应种族和舞台,显示年龄对OS没有显著影响;然而,接受非蒽环类药物联合治疗的≥70岁患者的DFS更差(风险比=0.349vs.1.049,p=0.0293)和DDFS(危险比=0.317与1.016,p=0.0251)比≤40岁的患者。调整年龄后的MV模型的DFS,种族,和疾病阶段,≥70岁患者的蒽环类+紫杉烷治疗与蒽环类+其他治疗之间的风险比在统计学上显着低于≤40岁患者(风险比[HRs]=0.349vs.1.049,p=0.0293)。
结论:我们的研究结果表明,与早期TNBC的年轻患者相比,老年人的DFS等结局较差,主要是那些没有接受蒽环类化疗方案的患者.
BACKGROUND: Despite lower chemotherapy use in older triple-negative breast cancer (TNBC) patients, their outcomes match younger counterparts. We compared outcomes in early-stage TNBC patients by age receiving chemotherapy at a major cancer center with a national TNBC database.
METHODS: Retrospective study using institutional data on stage I-III TNBC (ER/PR < 10%) women with neoadjuvant/adjuvant chemotherapy. Based on their ages at diagnosis, patients were stratified into four categories: ≤40, 41-59, 60-69, and ≥ 70 years. Demographic and clinical characteristics recorded included race, disease stage, ER/PR positivity, treatment regimen, lymphatic or vascular invasion (LVI), histologic grade, Ki-67 level, body mass index (BMI), and pathologic complete response (pCR) following neoadjuvant treatment and are summarized using descriptive statistics. The primary endpoints were overall survival (OS), disease-free survival (DFS), and distant disease-free survival (DDFS); all were estimated using the Kaplan-Meier method. Both univariate and multivariate (MV) Cox regressions were applied to evaluate the impact of important covariates on these time-to-event endpoints.
RESULTS: Of the 2336 patients studied, 492 (21.1%) were ≤ 40 years old, 1239 (53.1%) were 41-59, 461 (19.7%) were 60-69, and 144 (6.2%) were ≥ 70. In the univariate regression model of OS/DFS/DDFS, age ≥ 70 was significantly associated with worse OS (p = 0.0217); other factors associated with worse OS were non-
anthracycline-based chemotherapy, higher tumor stage, and neoadjuvant chemotherapy. The multivariate Cox regression model, adjusted for race and stage, showed no significant effects of age on OS; however, patients ≥ 70 years old who received non-
anthracycline treatment combinations had worse DFS (hazard ratio = 0.349 vs. 1.049, p = 0.0293) and DDFS (hazard ratio = 0.317 vs. 1.016, p = 0.0251) than patients ≤ 40 years old. DFS from MV model after adjusting for age, race, and disease stage, the hazard ratio between
anthracycline + taxane treatments and
anthracycline + other treatments in patients ≥ 70 years old was statistically significantly lower than in patients ≤ 40 years old (hazard ratios [HRs] = 0.349 vs. 1.049, p = 0.0293).
CONCLUSIONS: Our findings indicate that outcomes such as DFS are less favorable in older compared to younger patients with early-stage TNBC, primarily in those who did not receive an
anthracycline based chemotherapy regimen.