国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (11): 657-661.doi: 10.3760/cma.j.issn.1673-422X.2019.11.003

• 论著 • 上一篇    下一篇

我国老年晚期乳腺癌患者生存情况及治疗特点分析#br#

管秀雯，马飞，徐兵河   

  1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院内科100021
  • 出版日期:2019-11-08 发布日期:2019-12-26
  • 通讯作者: 马飞，徐兵河 E-mail:drmafei@126.com；xubinghebm@163.com

The landscape of palliative systemic therapy and overall survival analysis of elderly patients with advanced breast cancer in China National Cancer Center

Guan Xiuwen, Ma Fei, Xu Binghe   

  1. Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Online:2019-11-08 Published:2019-12-26
  • Contact: Ma Fei，Xu Binghe E-mail:drmafei@126.com；xubinghebm@163.com

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摘要： 目的通过真实世界数据对比中美老年晚期乳腺癌患者的生存情况，并对治疗方面的特点进行总结。方法分析2003年至2013年间首次于国家癌症中心（NCC）住院治疗的1 425例晚期乳腺癌患者中老年患者（≥60岁）与非老年患者的临床特征，并将生存数据与美国监测、流行病学和结果（SEER）数据库中21 185例晚期乳腺癌数据进行比较。结果NCC数据显示我国老年晚期乳腺癌的中位总生存期较非老年患者明显缩短（35.5个月 vs. 43.9个月，χ2=8.747，P=0.003）；SEER数据库中美国老年患者也具有相似的特征（24.0个月 vs. 36.0个月；χ2=540.227，P<0.001）。伴有高血压［30.3%（67/221） vs. 9.5%（114/1 204）；χ2=73.073，P<0.001］、糖尿病［14.5%（32/221） vs. 4.7%（57/1 204）；χ2=30.220，P<0.001］、心脏病［6.3%（14/221） vs. 1.7%（20/1 204）；χ2=17.638，P<0.001］的老年患者比例明显高于非老年组。对于雌激素受体（ER）和（或）孕激素受体(PR)阳性乳腺癌，老年患者接受一线初始内分泌治疗的比例明显高于非老年组［26.9%(43/160) vs. 9.5%(80/841)；χ2=37.599，P<0.001］；与一线接受化疗的患者相比，一线内分泌治疗可以给患者带来总生存获益（49.9个月 vs. 32.6个月，χ2=4.774，P=0.029）；而对于非老年患者，接受两种治疗方案的患者生存差异无统计学意义（56.9个月 vs. 48.8个月，χ2=1.103，P=0.294）。结论我国老年晚期乳腺癌患者合并高血压、糖尿病、心脏病的比例明显高于非老年患者，在治疗选择上也与非老年患者有所不同。与一线化疗相比，一线内分泌治疗可以为ER和（或）PR阳性的老年患者带来更多的生存获益。

关键词: 乳腺肿瘤, 老年人, 治疗, 药物疗法

Abstract: ObjectiveTo compare the survival data of elderly advanced breast cancer (ABC) patients in China National Cancer Center with USA and summarize the therapeutic characteristics in elderly ABC patients via real world study. MethodsWe summarized the clinicopathological characteristics, therapeutic regimens and survival outcome of 1 425 females with ABC who were initially hospitalized between January 2003 and December 2013 from Database in China National Cancer Center and compared with 21 185 ABC patients in the Surveillance, Epidemiology, and End Results (SEER) database. ResultsThe median overall survival (OS) of elderly patients was significantly shorter than that of the young group in China National Cancer Center (35.5 months vs. 43.9 months; χ2=8.747, P=0.003), which was similar to the survival feature in SEER database (24.0 months vs. 36.0 months; χ2=540.227, P<0.001). Compared with the young population, significantly more elderly patients suffered from the medical complications of hypertension ［30.3% (67/221) vs. 9.5% (114/1 204); χ2=73.073, P<0.001］, diabetes ［14.5% (32/221) vs. 4.7% (57/1 204); χ2=30.220, P<0.001］ and heart disease ［6.3% (14/221) vs. 1.7% (20/1 204); χ2=17.638, P<0.001］. In estrogen receptor (ER) and/or progesterone receptor (PR)-positive patients, the percentage of receiving first-line endocrine therapy in elderly patients was significantly larger than that of the young population ［26.9% (43/160) vs. 9.5% (80/841); χ2=37.599, P<0.001］. Moreover, in ER and/or PR-positive population, the elderly patients underwent first-line endocrine therapy resulted in better OS than those underwent first-line chemotherapy (49.9 months vs. 32.6 months; χ2=4.774, P=0.029), while no significant difference was observed between these two therapeutic modes in the young population (56.9 months vs. 48.8 months; χ2=1.103, P=0.294). ConclusionThe proportion of elderly ABC patients with the medical complication of hypertension, diabetes and heart disease is significantly larger than that of the young population, which may lead to the difference in treatment decision making. In ER and/or PR-positive elderly ABC patients, receiving first-line endocrine therapy may result in better survival than first-line chemotherapy.

Key words: Breast neoplasms, Aged, Therapy, Drug therapy