70岁以上老年乳腺癌临床病理特点和治疗体会

Clinical and pathological features and treatment experience of breast cancer patients aged over 70 years

目的探讨70岁以上老年乳腺癌患者的临床病理特点和治疗方式。方法回顾性分析2008年1月至2018年1月北京市第六医院外科收治的年龄大于70岁,且手术后病理明确诊断116例乳腺癌的临床资料。结果116例均为女性,平均年龄73岁,病程1周至5年,其中92例有伴发疾病。该组患者主要手术方式为乳癌改良根治术(乳房全切和腋窝清扫比例分别为70.2%和61.3%),术后病理浸润性癌占85.3%(99/116),其中黏液癌等特殊类型癌占6.9%(8/116),三阴乳腺癌占11.1%(11/99),HER2阳性乳腺癌占18.2%(18/99)。接受术后化疗者比例48.3%(56/116),内分泌治疗者55%(61/116)。术后中位随访时间44个月,术后复发率5.1%(5/99),乳腺癌相关死亡8例,伴发疾病相关死亡17例。结论老年性乳腺癌患者具有临床病理和分子生物学特点的特殊性,病程长,病期相对晚,伴发疾病较多,化疗耐受性差,内分泌治疗依从性较差,手术和内分泌治疗是主要和有效的治疗方法。

Objective To investigate the clinicopathological characteristics and treatment methods of breast cancer patients aged over 70 years.Methods Retrospective analysis was performed on the clinical data of 116 cases of breast cancer who were admitted to the Beijing Sixth Hospital from Jan.2008 to Jan.2018 and were over 70 years old.Results All the 116 cases were female with an average age of 73 years and a course of disease ranging from 1 week to 5 years.The main surgical methods of the patients in this group were modified radical mastectomy(total mastectomy and axillary dissection were 70.2%and 61.3%,respectively),postoperative pathological invasive cancer accounted for 85.3%(99/116),mucinous cancer and other special types of cancer accounted for 6.9%(8/116),triple-negative breast cancer accounted for 11.1%(11/99),and HER2-positive breast cancer accounted for 18.2%(18/99).The proportion of patients receiving postoperative chemotherapy was 48.3%(56/116)and that receiving endocrine therapy was 55%(61/116).The median follow-up time was 44 months,the postoperative recurrence rate was 5.1%(5/99),and during the follow-up time,8 cases of breast cancer-related deaths and 17 cases of disease-related deaths occurred.Conclusions Geriatric breast cancer patients have special characteristics of clinicopathology and molecular biology,with a long course of disease,relatively late disease period,many concomitant diseases,poor tolerance to chemotherapy,and poor compliance with endocrine therapy.Surgery and endocrine therapy are the main and effective treatment methods.