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Mortality impact of less-than-standard therapy in older breast cancer patients.

Abstract：

BACKGROUND:The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. STUDY DESIGN:This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics. RESULTS:We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR]=2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR=1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR=6.26, 95% CI, 3.10 to 12.64). CONCLUSIONS:Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Yood MU,Owusu C,Buist DS,Geiger AM,Field TS,Thwin SS,Lash TL,Prout MN,Wei F,Quinn VP,Frost FJ,Silliman RA

doi

10.1016/j.jamcollsurg.2007.07.015

subject

Has Abstract

pub_date

2008-01-01 00:00:00

pages

66-75

issue

1

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(07)01246-X

journal_volume

206

pub_type

杂志文章,多中心研究

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