Publication: Influencia de la edad como factor pronóstico en la decisión terapéutica y de supervivencia en el cáncer de mama
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2017-08-31
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Universidad Complutense de Madrid
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Abstract
El aumento de la esperanza de vida en los países desarrollados y la circunstancia de que casi la mitad de los cánceres de mama suceden en las pacientes de 65 o más años, augura un incremento en la prevalencia de esta enfermedad en los próximos años. A pesar de que los cánceres de mama en las pacientes de > 70 años suelen de histología más indolente, en su mayoría tumores hormonosensibles tipo luminal A, la mortalidad especifica de edad es alta. Entre los factores que pueden determinar el aumento de la mortalidad especifica de enfermedad se encuentran: una menor adherencia al tratamiento, incluyendo terapias poco tóxicas como la hormonoterapia, la realización de un abordaje local menos radical, selección de terapias menos eficaces y tóxicas, y el presentimiento de una mayor toxicidad en estas pacientes de las terapias estándar. La escasez de ensayos clínicos donde se incluyan este tipo de pacientes de edad avanzada hace que no se tenga información sobre la eficacia y la toxicidad real de los tratamientos en estas pacientes. OBJETIVOS: Se ha realizado un estudio retrospectivo de seguimiento ( cohortes ) de 2126 pacientes con cáncer de mama desde el 1 de Enero del año 2006 al 1 de Enero del año 2011 obtenido en el registro de cáncer de mama en el Hospital General Universitario Gregorio Marañón de Madrid. El objetivo es analizar la influencia de la edad en el pronóstico, en la decisión terapéutica y en la supervivencia de la enfermedad...
The increase of the life expectancy in developed countries and the fact that almost half of breast cancers occur in the patients of 65 years or more, predicts an increase in the prevalence of this disease in the coming years. While breast cancers in patients > 70 years are usually more indolent histology, mostly tumors type luminal A, mortality specified age is high. Among the factors that can determine the increase in mortality disease specific are: a less adherence to treatment, including therapies little toxic as hormone therapy, the perfom of a less radical local approach, a selection of noneffective and less toxic therapies, and the feeling of a greater toxicity in these patients of the standard therapies. The shortage of clinical trials including patients of advanced age makes that we have scarce information available on the effectiveness and the toxicity of treatments in these patients. Objetives: This is a retrospective follow‐up study (cohort) of 2126 patients with breast cancer since January 1 of the year 2006 to January 1 of the year 2011 in the registration of breast cancer in the Hospital General Universitario Gregorio Marañón in Madrid. We analyze the influence of age on the prognosis, in the therapeutic decision and in the survival of the disease. This divides the age into two groups: patients < 70 and 70 or more years and discusses the difference in the independent variables such as karnosfky index, the stage, the degree of tumor differentiation, type biological tumor, suitability of the surgery, adequacy of global treatment, refusal of treatment, biochemical parameters (blood count, liver and renal function), risk of cardiac toxicity and morbidity. As dependent variables are the type of therapy: surgery, radiotherapy, chemotherapy, endocrine therapy, biologic therapy, and therapy palliative...
The increase of the life expectancy in developed countries and the fact that almost half of breast cancers occur in the patients of 65 years or more, predicts an increase in the prevalence of this disease in the coming years. While breast cancers in patients > 70 years are usually more indolent histology, mostly tumors type luminal A, mortality specified age is high. Among the factors that can determine the increase in mortality disease specific are: a less adherence to treatment, including therapies little toxic as hormone therapy, the perfom of a less radical local approach, a selection of noneffective and less toxic therapies, and the feeling of a greater toxicity in these patients of the standard therapies. The shortage of clinical trials including patients of advanced age makes that we have scarce information available on the effectiveness and the toxicity of treatments in these patients. Objetives: This is a retrospective follow‐up study (cohort) of 2126 patients with breast cancer since January 1 of the year 2006 to January 1 of the year 2011 in the registration of breast cancer in the Hospital General Universitario Gregorio Marañón in Madrid. We analyze the influence of age on the prognosis, in the therapeutic decision and in the survival of the disease. This divides the age into two groups: patients < 70 and 70 or more years and discusses the difference in the independent variables such as karnosfky index, the stage, the degree of tumor differentiation, type biological tumor, suitability of the surgery, adequacy of global treatment, refusal of treatment, biochemical parameters (blood count, liver and renal function), risk of cardiac toxicity and morbidity. As dependent variables are the type of therapy: surgery, radiotherapy, chemotherapy, endocrine therapy, biologic therapy, and therapy palliative...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 08-02-2016