Primary endocrine therapy (PET) offers non-surgical treatment for older women with early-stage breast cancer who are unsuitable for surgery due to frailty or comorbidity. This research assessed all-cause and breast cancer-specific mortality of PET vs. surgery in older women (≥70 years) with oestrogen-receptor-positive early-stage breast cancer by frailty and comorbidity levels. This study used UK secondary data to analyse older female patients from 2000 to 2016. Patients were censored until 31 May 2019 and grouped by the Charlson comorbidity index (CCI) and hospital frailty risk score (HFRS). Cox regression models compared all-cause and breast cancer-specific mortality between PET and surgery within each group, adjusting for patient preferences and covariates. Sensitivity analyses accounted for competing risks. There were 23,109 patients included. The hazard ratio (HR) comparing PET to surgery for overall survival decreased significantly from 2.1 (95%CI: 2.0, 2.2) to 1.2 (95%CI: 1.1, 1.5) with increasing HFRS and from 2.1 (95%CI: 2.0, 2.2) to 1.4 (95%CI 1.2, 1.7) with rising CCI. However, there was no difference in BCSM for frail older women (HR: 1.2; 0.9, 1.9). There were no differences in competing risk profiles between other causes of death and breast cancer-specific mortality with PET versus surgery, with a subdistribution hazard ratio of 1.1 (0.9, 1.4) for high-level HFRS (p= 0.261) and CCI (p= 0.093). Given limited survival gains from surgery for older patients, PET shows potential as an effective option for frail older women with early-stage breast cancer. Despite surgery outperforming PET, surgery loses its edge as frailty increases, with negligible differences in the very frail.
原发性内分泌治疗（PET）为因虚弱或合并症而不适合手术的老年早期乳腺癌患者提供了非手术治疗选择。本研究通过虚弱程度和合并症水平，评估了70岁及以上雌激素受体阳性早期乳腺癌老年女性患者接受PET与手术治疗的全因死亡率和乳腺癌特异性死亡率。本研究利用英国2000年至2016年的二手数据进行分析，患者随访截止至2019年5月31日，并根据查尔森合并症指数（CCI）和医院虚弱风险评分（HFRS）进行分组。通过Cox回归模型比较各组内PET与手术治疗的全因死亡率和乳腺癌特异性死亡率，并调整患者偏好和协变量。敏感性分析考虑了竞争风险。共纳入23,109例患者。随着HFRS评分升高，PET与手术相比的全因死亡风险比（HR）从2.1（95%CI：2.0-2.2）显著下降至1.2（95%CI：1.1-1.5）；随着CCI评分升高，HR从2.1（95%CI：2.0-2.2）下降至1.4（95%CI：1.2-1.7）。然而，在虚弱老年女性中，PET与手术的乳腺癌特异性死亡率无显著差异（HR：1.2；95%CI：0.9-1.9）。在考虑竞争风险后，PET与手术在其他死因与乳腺癌特异性死亡率方面未显示差异：高水平HFRS组的次分布风险比为1.1（95%CI：0.9-1.4，p=0.261），CCI组为p=0.093。鉴于手术对老年患者的生存获益有限，PET显示出作为虚弱老年女性早期乳腺癌患者有效治疗选择的潜力。尽管手术效果优于PET，但随着虚弱程度增加，手术优势逐渐减弱，在极度虚弱患者中两者差异可忽略不计。
肿瘤(癌症)患者之家