老年乳腺癌患者的综合治疗方式选择倾向及其影响因素

Tendency of elderly patients with breast cancer to choose comprehensive treatment mode and its influencing factors

目的分析老年乳腺癌患者在治疗方式选择方面的倾向及相关的影响因素。方法收集2013年1月至2017年12月在运城市中心医院接受治疗的老年乳腺癌单侧病变患者312例的数据资料实施回顾性分析。分析所有患者的治疗方式选择情况,对比选择不同治疗方式患者的年龄。采用单因素及logistic多因素回归分析老年乳腺癌患者化疗选择倾向,采用Cox比例风险模型分析老年乳腺癌患者5年生存情况的影响因素。结果所有患者中,手术、化疗、放疗、内分泌治疗、靶向治疗的选择百分比分别为97.44%(304/312)、81.41%(254/312)、7.05%(22/312)、68.27%(213/312)、3.85%(32/312)。全部患者的年龄为(67.94±6.55)岁。不同治疗方式患者的年龄对比,差异均无统计学意义(均P>0.05)。单因素分析结果显示,化疗与未化疗患者的浸润癌深度(t=3.11,P=0.002)、腋窝淋巴结转移数量(t=6.54,P<0.001)、合并症(t=-4.85,P<0.001)、美国东部肿瘤协作组(ECOG)评分(t=-4.56,P<0.001)差异均有统计学意义,年龄(t=-0.52,P=0.604)、病理类型(χ^(2)=4.96,P=0.084)、手术类型(χ^(2)=0.21,P=0.899)、肿瘤分化程度(χ^(2)=3.28,P=0.194)、雌激素受体(χ^(2)=0.99,P=0.321)、孕激素受体(χ^(2)=0.89,P=0.346)、人表皮生长因子受体-2(χ^(2)=0.58,P=0.445)差异均无统计学意义。多因素分析结果显示,合并症(OR=0.91,95%CI为0.85~0.99,P=0.024)、ECOG评分(OR=0.95,95%CI为0.92~0.99,P=0.007)为老年乳腺癌患者在手术后使用化疗的独立影响因素。在术后5年内,共有74例患者死亡,术后5年总生存率为76.28%。患者较多的腋窝淋巴结转移数量(RR=1.26,95%CI为1.09~1.46,P=0.001)、合并症(RR=1.07,95%CI为1.02~1.13,P=0.007)均为影响患者预后的独立危险因素。结论手术和化疗为乳腺癌老年患者的主要治疗方式,ECOG评分以及合并症数量可直接影响该类患者的化疗选择结果,腋窝淋巴结转移数量、合并症对于患者的远期生存情况有显著影响。

Objective To analyze the tendency of elderly patients with breast cancer in the choice of treatment methods and related influencing factors.Methods The data of 312 elderly patients with unilateral breast cancer treated in Yuncheng Central Hospital from January 2013 to December 2017 were collected for retrospective analysis.All patients'treatment options were analyzed,and the age of patients who chose different treatment options was compared.Univariate and logistic regression were used to analyze the chemotherapy choice tendency of elderly breast cancer patients,and Cox proportional risk model was used to analyze the influencing factors of 5-year survival of elderly breast cancer patients.Results In the whole patient population,the selection rates of surgery,chemotherapy,radiotherapy,endocrine therapy and targeted therapy were respectively 97.44%(304/312),81.41%(254/312),7.05%(22/312),68.27%(213/312),3.85%(32/312).The mean age of all patients was(67.94±6.55)years.There were no statistically significant differences in the age of patients with different treatment methods(all P>0.05).The results of univariate analysis showed that,there were statistically significant differences in the depth of invasive cancer(t=3.11,P=0.002),number of axillary lymph node metastasis(t=6.54,P<0.001),comorbidities(t=-4.85,P<0.001)and Eastern Cooperative Oncology Group(ECOG)score(t=-4.56,P<0.001)between chemotherapy and nonchemotherapy patients,and there were no statistically significant differences in age(t=-0.52,P=0.604),pathological type(χ^(2)=4.96,P=0.084),surgical type(χ^(2)=0.21,P=0.899),tumor differentiation degree(χ^(2)=3.28,P=0.194),estrogen receptor(χ^(2)=0.99,P=0.321),progesterone receptor(χ^(2)=0.89,P=0.346),and human epidermal growth factor receptor-2(χ^(2)=0.58,P=0.445).The results of multifactor analysis showed that types of comorbidities(OR=0.91,95%CI:0.85-0.99,P=0.024)and ECOG score(OR=0.95,95%CI:0.92-0.99,P=0.007)were independent influencing factors for the use of chemotherapy after surgery in elderly breast cancer patients.A total of 74 patients died within 5 years after surgery,and the 5-year overall survival rate was 76.28%.More axillary lymph node metastasis(RR=1.26,95%CI:1.09-1.46,P=0.001)and more complications(RR=1.07,95%CI:1.02-1.13,P=0.007)were risk factors for prognosis.Conclusion Surgery and chemotherapy are the main treatment methods for elderly patients with breast cancer.ECOG score and number of complications can directly affect the results of chemotherapy selection for such patients,the number of axillary lymph node metastasis and complications had significant influence on the long-term survival of the patients.