65岁以上老年乳腺癌患者的治疗方式及影响因素

Treatment patterns and affecting factors in breast cancer patients over 65-years of age

目的探讨65岁以上老年乳腺癌患者的治疗方式及影响因素。方法收集2009年1月至2010年12月间手术治疗的126例65岁以上老年乳腺癌患者的临床资料，记录患者年龄、治疗方式、临床病理特点、合并症和生存率等，分析其治疗方式的差异及其影响因素。结果126例患者按年龄分为65～74岁组和〉74岁组，其中65～74岁组71例，〉74岁组55例。65～74岁组和〉74岁组患者的手术方式主要为改良根治术（分别为84．5％和89．1％），接受术后辅助化疗的比例分别为73．2％和54．5％，接受内分泌治疗的比例分别为67．6％和61．8％，接受术后放疗的比例分别为19．7％和7．3％。老年乳腺癌的化疗与患者年龄、病理类型、孕激素受体（PR）表达情况和有无合并症有关，老年乳腺癌的放疗与患者年龄、手术方式、TNM分期、淋巴结转移情况有关（均P〈0．05）。多因素分析显示，患者年龄、病理类型、PR表达情况和有无合并症为老年乳腺癌化疗的独立影响因素（均P〈0．05），患者年龄和手术方式为老年乳腺癌放疗的独立影响因素（均P〈0．05）。126例老年乳腺癌患者的3年无复发生存率和3年总生存率分别为91．3％和92．0％，其中内分泌治疗与老年乳腺癌患者的3年无复发生存率有关（P=0．038），年龄与老年乳腺癌患者的3年总生存率有关（P=0．037）。结论65岁以上老年乳腺癌患者的手术及内分泌治疗方式不受年龄影响；术后辅助化疗及放疗的比例随患者年龄的增加而降低，这与患者的病理类型、PR表达、手术方式及合并症等有关；老年乳腺癌患者的3年生存率仅与年龄有关。

Objective To explore different therapies and affecting factors in breast cancer patients ≥65 years old. Methods To retrospectively analyze the clinical characteristics, treatments, comorbidity and survival rate of 126 female breast cancer patients over 65 years old who underwent surgical operation in our hospital from January 2009 to December 2010. To compare and analyze the differences in the treatment patterns, and find out the affecting factors. Results One hundred and twenty-six cases were included in this retrospective study, and they were divided into two groups according to age： 65-74 years old group （71 cases） and 〉 74 years group （55 cases ）. Most patients in the two groups received modified radical mastectomy （84.5% and 89.1% ） ; 73.2% and 54.5% of patients received adjuvant chemotherapy in the two groups, respectively. 67.6% and 61.8% of the patients had adjuvant endocrine therapy respectively. 19.7% and 7.3% of the patients received radiotherapy, respectively. Chemotherapy in elderly breast cancer patients was correlated with age, pathological types, progesterone receptor （PR） status and comorbidity. Radiotherapy in elderly breast cancer patients was related to age, surgeical patterns, TNM stage and lymph node status. Multivariate analysis showed that age, pathological types, PR expression and comorbidity were independent factors affecting choice of chemotherapy in elderly breast cancer patients （ P 〈 O. 05 for all）. Age and surgical patterns were independent factors affecting choice of radiotherapy （P 〈0.05 for all）. The 3-year disease-free survival （DFS） rate and overall survival （OS） rate in these patients were 91.3% and 92.0% , respectively. Furthermore, endocrine therapy was related to 3-year DFS rate （ P = 0. 038 ） and age was correlated with 3-year OS rate （P = 0. 037） in these elderly patients. Conclusions Breast cancer in the elderly patients receive similar surgery and endocrine therapy, but the elderly patients are less likely to have chemotherapy and radiotherapy, due to age, PR expression, pathological types, surgical patterns and comorhidity. Only age contributes to the lower 3-year overall survival rate in 〉74-year old patients.