65岁以上中国老年女性原发性乳腺癌临床病理特征及治疗分析：多中心10年回顾性研究

目的]研究65岁以上老年女性原发性乳腺癌的风险暴露因素、临床病理特征以及治疗特征,为老年女性乳腺癌的诊治提供依据.方法]回顾性分析全国7个不同地区具有代表性的7家医院收集的4211例乳腺癌患者信息,将65岁以上患者作为研究对象(老年组),50～64岁年龄组作为对照组.统计学方法为卡方检验和Fisher精确检验,P＜0.05具有统计学意义.结果]65岁以上老年乳腺癌患者占同期乳腺癌患者的8.33％(351/4211).平均诊断年龄和平均绝经年龄分别为70.2岁(65～86岁)和49.59岁(32～58岁).与对照组相比,老年组具有以下特征:以体力工作、生育大于一胎、低学历、结婚早和初次生育年龄早者显著;临床病理特征方面,老年患者区域淋巴结转移少、分期早(即更多的0+Ⅰ+Ⅱ期患者)、激素受体阳性率高、Hey2低表达、Her-2亚型和三阴性亚型少.在侵袭性治疗方面,老年患者较少接受改良根治术、保乳术、放疗、化疗,更多的是接受乳腺单纯切除术.两组间内分泌治疗无显著差异.结论]老年乳腺癌患者有较好的临床病理特征和生物学行为;接受侵袭性治疗少;内分泌治疗需要加强.

Clinicopathologic Characteristics and Treatment Patterns of Primary Breast Cancer in Elderly Women:A Retrospective Multicenter Study

Purpose] To investigate the clinicopathological characteristics and therapeutic patterns of breast cancer in elderly women.Methods] The medical records of 4211 female patients with breast cancer were collected from 7 representative regions of China from 1999 to 2008.Data of risk factors,clinicopathological characteristics and treatment patterns were extracted and analyzed.Results] Of 4211 patients,351 (8.33％) patients were ≥65 years of age (elderly group).In elderly group the mean age at the diagnosis was 70.2 years(65～86 years) and the mean age of menopause was 49.6 years(32～58 years).Compared to patients aged 50～64 years (control group),a larger proportion of patients in elderly group engaging in manual labors(P=0.034),having multiple birth(P＜0.001),younger primiparous age(P=0.001) and less school education (P=0.018).Compare to control group,the elderly patients had axillary lymph node metastasis less frequently(P=0.001),more early-stages(stage 0,Ⅰ and Ⅱ) disease(P=0.030),less Her-2 overexpression (P=0.005),more ER/PR positivity (P=0.012);for molecular subtypes,elderly patients had less Her-2 phenotype(P＜0.001) and less basal-like phenotype(P＜0.001).Compared to control group,lower proportion of elderly patients received modified radical mastectomy (P＜0.001),breastconserving surgery(P＜0.001),chemotherapy(P＜0.001) and radiotherapy(P＜0.001),while the elderly patients had simple mastectomy more frequently(P＜0.001),and less endocrine therapy.Conclusion] Elderly breast cancer patients have a more favorable clinicopathologic profile and receive less aggressive therapy as compared to the younger counterparts.However,endocrine therapy needs to be strengthened.