不同衰弱水平对老年非手术乳腺癌患者放化疗预后的影响

Influence of frailty levels on the prognosis of elderly patients with non-operative breast cancer received radiotherapy and chemotherapy

目的研究不同衰弱水平对老年非手术乳腺癌患者放化疗预后的影响。方法选择2015年1—12月本院肿瘤科接诊并经病理学证实的120例老年非手术乳腺癌患者作为研究对象,按衰弱指数(FI)分为非衰弱组、衰弱前期组和衰弱组三组,其中非衰弱组37例,衰弱前期组48例和衰弱组35例。对各组患者予以相应的放化疗治疗,观察并记录各组患者在治疗过程中出现的不良反应发生率、3年生存率和5年生存率。采用Kaplan-Meier法绘制生存曲线。结果非衰弱组、衰弱前期组和衰弱组不良反应发生率分别为24.32%(9/37)、37.50%(18/48)和60.00%(21/35),组间差异有统计学意义(χ^(2)=9.747,P=0.008);非衰弱组、衰弱前期组和衰弱组发生率最高的不良反应分别是贫血(40.54%)、中性粒细胞减少(41.67%)、中性粒细胞减少(51.43%);随着衰弱水平的增长,粒细胞减少的发生率呈明显的升高趋势,差异有统计学意义(χ^(2)=12.429,P=0.002);三组患者3年生存率比较,差异无统计学意义(P>0.05);非衰弱组患者5年生存率明显高于衰弱前组、衰弱组,差异有统计学意义(P<0.05)。结论不同衰弱水平的老年非手术乳腺癌患者,其放化疗的预后是不同的,衰弱水平越高,预后越差。在临床上,相较于单一地按照指标来对老年乳腺癌患者进行放化疗治疗,结合患者的衰弱评估状态为其制定个体化诊疗方案,有利于改善患者的预后。

Objective To study the influence of different levels of frailty on the prognosis of elderly patients with non-operative breast cancer received radiotherapy and chemotherapy.Methods One hundred and twenty elderly patients with non-operative breast cancer treated in our hospital from January 2015 to December 2015 were enrolled as study objects,and they were divided into non-frailty group(n=37),pre-frailty group(n=48)and frailty group(n=35)according to frailty index(FI).Patients in each group were treated with radiotherapy and chemotherapy,and the incidence of adverse reactions,3-year survival rate and 5-year survival rate in each group were observed and recorded.Kaplan-Meier method was used to draw the survival curve.Results The results of this study showed that the incidence of adverse reactions in non-frailty group,pre-frailty group and frailty group were 24.32%(9/37),35.50%(18/48),60.00%(12/35),respectively,and the difference wasstatistically significant(χ^(2)=9.747,P=0.008).The highest incidence of adverse reactions in non-frailty group,pre-frailty group and frailty group was anemia(40.54%),neutropenia(41.67%)and(51.43%).The incidence of granulocytopenia increased with the increase of frailty level,and the difference was statistically significant(χ^(2)=12.429,P=0.002).There was no significant difference in 3-year survival rate among the 3 groups(P>0.05).The 5-year survival rate in the non-frailty group was significantly higher than that in the pre-frailty group and frailty group,and the difference was statistically significant(P<0.05).Conclusions The prognosis of radiotherapy and chemotherapy is different in elderly patients with non-operative breast cancer with different levels of frailty,and the higher the level of frailty is,the worse the prognosis is.In clinical practice,compared with radiotherapy and chemotherapy for elderly patients with breast cancer based on single indicators,individualized diagnosis and treatment plans formulated based on the frailty assessment status of patientsis beneficial to improve the prognosis of patients.