70岁以上老年浸润性乳腺癌患者的临床病理特点、治疗现状及预后分析

目的 分析70岁以上老年女性浸润性乳腺癌患者的临床及病理特点、治疗方式、生存情况及影响预后的因素。方法 收集178例70岁以上老年浸润性乳腺癌患者的临床资料、随访生存情况，统计分析其临床病理特点、生存率及影响治疗方案选择和预后的因素。结果 全组178例患者，83.7%的患者合并至少一种伴随疾病。T1、T2期患者分别占46.1%、36.5%，多为浸润性导管癌，ER和（或）PR阳性的患者占81.6%。多因素分析显示肿瘤大小、淋巴结转移、TNM分期、PR状态、并发症情况、腋窝手术方式是影响患者是否接受化疗的独立因素；年龄是影响患者是否接受放疗的唯一独立因素。中位随访51月，3、5年无病生存率分别为91.8%和80.5%，3年的总生存率为94%。肿瘤大小、淋巴结转移情况、TNM分期、是否行手术治疗是影响老年浸润性乳腺癌患者生存的影响因素。治疗不足，尤其是化疗不足会影响老年患者生存，但结果差异未见统计学意义。结论 老年浸润性乳腺癌以早期患者为主，预后较好，影响治疗的主要因素集中在肿瘤分期、分子分型及年龄并发症情况。多数患者死亡原因为非乳腺癌相关原因，手术治疗仍是提高患者生存的主要干预手段。

Clinicopathological Features,Treatment and Prognosis of Invasive Breast Cancer Patients over 70 Years Old

Objective To investigate the clinicopathological characteristics, treatment patterns and prognosis factors of female invasive breast cancer patients over 70 years old. Methods A total of 178 female invasive breast cancer patients over 70 years old were included in this retrospective study. Their clinicopathological characteristics, treatment options, including operation and adjuvant treatment, overall survival and prognostic factors were analyzed. Results These 178 patients accounted for 12.4% of all breast cancer patients registered in our institution during the same period; 83.7% of these patients were complicated with at least one comorbidity; stage T1 and T2 patients accounted for 46.1% and 36.5%, respectively, and major pathological type was invasive ductal carcinoma; positive ER and(or) PR patients accounted for 81.6%. Tumor size, lymph node status, TNM stage, PR status, comorbidities and axillary operation were found to be independent factors to influence chemotherapy by multivariate analysis. Age was the only factor to influence radiotherapy. The median follow-up was 51 months, the cumulative 3- and 5-year disease-free survival were 91.8% and 80.5%, and the 3-year overall survival was 94%. Factors affecting the prognosis were tumor size, lymph node status, TNM stage and operation options by univariate analysis. Insufficient treatment, especially insufficient chemotherapy, would affect elderly breast cancer patients’ survival, without significant difference. Conclusion Female breast cancer patients over 70 years old are mainly with early-stage cancer, good pathologic types and prognosis. Treatment options are influenced by TNM stage, molecular types, age and comorbidities. Most causes of death are nonbreast cancer specific. Surgery is still the most important treatment method to improve patients’ survival.