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

doi:10.3760/cma.j.cn371439-20230315-00123

Abstract

Abstract:

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 non-chemotherapy patients，and there were no statistically significant differences in age （t=-0.52，P=0.604），pathological type （χ²=4.96，P=0.084），surgical type （χ²=0.21，P=0.899），tumor differentiation degree （χ²=3.28，P=0.194），estrogen receptor （χ²=0.99，P=0.321），progesterone receptor （χ²=0.89，P=0.346），and human epidermal growth factor receptor-2 （χ²=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.

Key words: Old age, Breast neoplasms, Treatment mode, Chemotherapy, Radiotherapy, Complication

Geng Rui, Ma Junqiang, Guo Qiang, Niu Zhaofeng. Tendency of elderly patients with breast cancer to choose comprehensive treatment mode and its influencing factors[J]. Journal of International Oncology, 2023, 50(11): 650-654.

Figures/Tables 4

References 21

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项目	例（%）	年龄（$\bar{x}$±s，岁）	t值	P值
手术
是	304（97.44）	67.21±5.54	-0.41	0.679
否	8（2.56）	68.03±5.12	-0.41	0.679
化疗
是	254（81.41）	67.72±5.08	-0.52	0.604
否	58（18.59）	68.12±6.13	-0.52	0.604
放疗
是	22（7.05）	66.99±5.48	-0.95	0.342
否	290（92.95）	68.23±5.92	-0.95	0.342
内分泌治疗
是	213（68.27）	68.10±6.13	0.62	0.538
否	99（31.73）	67.65±5.73	0.62	0.538
靶向治疗
是	32（3.85）	67.73±5.96	-0.45	0.653
否	280（96.15）	68.25±6.22	-0.45	0.653

项目	化疗（n=254）	未化疗（n=58）	t/χ²值	P值
年龄（岁）	67.72±5.08	68.12±6.13	-0.52	0.604
病理类型
浸润性导管癌	199（78.35）	38（65.52）
原位癌	17（6.69）	8（13.79）	4.96	0.084
其他类型	38（14.96）	12（20.69）
手术类型
保乳手术	58（22.83）	13（22.41）
改良根治术	189（74.41）	44（75.86）	0.21	0.899
其他	7（2.76）	1（1.72）
浸润癌深度（cm）	2.85±1.42	2.23±1.13	3.11	0.002
肿瘤分化程度
低分化	162（63.78）	32（55.17）
中分化	80（31.50）	20（34.48）	3.28	0.194
高分化	12（4.72）	6（10.34）
腋窝淋巴结转移数量（枚）	6.35±2.32	4.18±2.10	6.54	<0.001
雌激素受体
阴性	135（53.15）	35（60.34）	0.99	0.321
阳性	119（46.85）	23（39.66）	0.99	0.321
孕激素受体
阴性	140（55.12）	28（48.28）	0.89	0.346
阳性	114（44.88）	30（51.72）	0.89	0.346
人表皮生长因子受体-2
阴性	194（76.38）	47（81.03）	0.58	0.445
阳性	60（23.62）	11（18.97）	0.58	0.445
合并症（种）	2.12±1.08	2.86±0.89	-4.85	<0.001
ECOG评分（分）	1.73±0.51	2.08±0.60	-4.56	<0.001

影响因素	b值	S.E.值	Waldχ²值	OR值	95%CI	P值
浸润癌深度	0.10	0.06	2.71	1.11	0.98~1.25	0.099
腋窝淋巴结转移数量	0.23	0.15	2.54	1.26	0.95~1.67	0.111
合并症	-0.09	0.04	5.08	0.91	0.85~0.99	0.024
ECOG评分	-0.05	0.02	7.08	0.95	0.92~0.99	0.007

影响因素	单因素分析				多因素分析
影响因素	b值	RR值	95%CI	P值	b值	RR值	95%CI	P值
年龄	0.09	1.09	0.95~1.26	0.229
病理类型（浸润性导管癌为对照）
原位癌	1.25	3.50	0.60~20.31	0.162
其他类型	1.12	3.05	0.68~13.63	0.144
手术类型（保乳手术为对照）
改良根治术	2.35	10.53	0.85~130.40	0.066
其他	1.80	6.07	0.55~66.69	0.140
浸润癌深度	0.05	1.05	0.98~1.12	0.170
肿瘤分化程度（高分化为对照）
中分化	1.94	6.92	0.34~134.00	0.207
低分化	2.37	10.67	0.21~534.39	0.235
腋窝淋巴结转移数量	0.35	1.42	1.14~1.76	0.001	0.24	1.26	1.09~1.46	0.001
雌激素受体（阳性为对照）	1.36	3.88	0.66~22.85	0.133
孕激素受体（阳性为对照）	1.40	4.06	0.56~29.27	0.164
人表皮生长因子受体-2（阳性为对照）	1.29	3.63	0.42~31.59	0.242
合并症	0.05	1.05	1.03~1.07	0.001	0.07	1.07	1.02~1.13	0.007
ECOG评分	0.04	1.04	0.99~1.09	0.161