中山大学学报（医学科学版）2025，Vol.46Issue(2)：335-344,10.
全乳放疗在70岁以上老年乳腺癌预后中的临床价值分析
Clinical Value Analysis of Whole-breast Radiotherapy in the Prognosis of Women Aged 70 Years or Older with Breast Cancer
摘要
Abstract
[Objective]To investigate the prognostic role of radiotherapy in women aged 70 years or older with breast cancer.[Methods]A total of 311 women aged 70 years or older with breast cancer undergoing breast-conserving surgery in the Second Affiliated Hospital of Nanchang University between February 28,2011 and February 28,2021,were divided into two groups:183 patients in the control group were given postoperative radiotherapy,and 128 patients in the case group were not treated by radiotherapy.The nonparametric Mann-Whitney U test or χ2 test was used to compare the general clinicopathological data of the two groups,the Kaplan-Meier method and log-rank test to analyze the disease-free survival(DFS)and overall survival(OS),multivariate Cox proportional hazards regression model to examine the factors affecting DFS and OS.Additional subgroup analysis was performed.[Results]There were no statistically significant differences between the control and case groups in age,T-stage,N-stage,tumor clinical stage,estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor type 2(HER2)statuses,Ki-67,tumor histological grade,tumor pathological type,and whether they received adjuvant chemotherapy or postoperative endocrine therapy(all P>0.05).The median follow-up was 110.0(95%CI:98.9,121.1)months for the control group and 93.0(95%CI:86.1,100.0)months for the case group.Differences between the two groups in DFS rate were significant(92.9%vs.85.2%,P=0.024),but in OS rate insignificant(92.3%vs.88.3%,P=0.199).Multivariate Cox proportional hazards regression analysis showed that T-stage,N-stage(N2 and N3),HER2 status,Ki-67,tumor histological grade(grade Ⅱ and Ⅲ),and no radiotherapy were independent risk factors for DFS in elderly breast cancer patients(all P<0.05),while ER status was an independent protective factor(P<0.05).The independent risk factors for OS in elderly breast cancer patients included tumor stage,N-stage(N2 and N3),HER2 status,and Ki-67(all P<0.05),and ER status was an independent protective factor(P<0.05).Subgroup analysis revealed that in elderly hormone receptor(HR)-negative breast cancer patients,the median follow-ups of the control and case groups were 123.0(95%CI:116.8,129.2)months and 88.0(95%CI:75.2,100.8)months,respectively,with a statistically significant difference both in DFS(91.3%vs.68.6%,P=0.008)and OS rates(89.1%vs.71.4%,P=0.027).[Conclusions]Post-breast-conserving radiotherapy provides a limited survival benefit in the overall elderly breast cancer patients,but a significant survival benefit in the elderly HR-negative breast cancer patients,which suggests the need for a prospective randomized controlled trial of a stratified step-down strategy for radiotherapy in elderly breast cancer patients.关键词
老年乳腺癌/保乳手术/放疗/无病生存期/总生存期Key words
elderly breast cancer/breast-conserving surgery/radiotherapy/disease-free survival/overall survival分类
医药卫生引用本文复制引用
夏坤健,唐娜,李顶..全乳放疗在70岁以上老年乳腺癌预后中的临床价值分析[J].中山大学学报（医学科学版）,2025,46(2):335-344,10.基金项目
江西省卫生健康委科技计划(SKJP220211021) （SKJP220211021）
