本研究评估了早期浸润性乳腺癌女性中年龄、合并症和虚弱对保乳手术 (BCS) 联合放疗 (RT) 与乳房切除术（联合或不联合 RT）后 5 年生存结果的影响。从癌症登记数据中确定了在英格兰（2014-2019）诊断出患有早期浸润性乳腺癌的 50 名接受过乳房手术的人。生存估计是根据灵活的参数生存模型计算的。竞争风险方法用于乳腺癌特异性生存（BCSS）。按年龄计算每种治疗的乳腺癌死亡的标准化生存概率和累积发生率函数。在 101 654 名女性中，72.2% 接受了 BCS RT，27.8% 接受了乳房切除术。年龄、合并症和虚弱与总生存期 (OS) 相关，但只有年龄和合并症与 BCSS 相关。 BCS RT 的 OS 生存概率 (90.3%) 高于乳房切除术 (87.0%)，并且治疗之间的差异因年龄而异（50 岁：1.9% 与 80 岁：6.5%）。乳房切除术后乳腺癌死亡的累积发生率函数 (5.1%) 高于 BCS RT (3.9%)，但年龄差异几乎没有变化 (50 岁：0.9% 与 80 岁：1.2%)。结果强调了与 BCSS 的稳定基线相比，OS 的基线死亡风险随年龄的变化。对于 OS，BCS RT 和乳房切除术的生存概率差异随着年龄的增长而略有增加。无论年龄如何，不同手术类型的乳腺癌死亡累积发生率函数的差异都很小。关于老年乳腺癌人群现实世界生存结果的证据可为治疗决策提供信息。© 作者 2024。由牛津大学出版社代表 BJS Foundation Ltd 出版。

This study assessed the influence of age, co-morbidity and frailty on 5-year survival outcomes after breast conservation surgery (BCS) with radiotherapy (RT) versus mastectomy (with or without RT) in women with early invasive breast cancer.Women aged over 50 years with early invasive breast cancer diagnosed in England (2014-2019) who had breast surgery were identified from Cancer Registry data. Survival estimates were calculated from a flexible parametric survival model. A competing risk approach was used for breast cancer-specific survival (BCSS). Standardized survival probabilities and cumulative incidence functions for breast cancer death were calculated for each treatment by age.Among 101 654 women, 72.2% received BCS + RT and 27.8% received mastectomy. Age, co-morbidity and frailty were associated with overall survival (OS), but only age and co-morbidity were associated with BCSS. Survival probabilities for OS were greater for BCS + RT (90.3%) versus mastectomy (87.0%), and the difference between treatments varied by age (50 years: 1.9% versus 80 years: 6.5%). Cumulative incidence functions for breast cancer death were higher after mastectomy (5.1%) versus BCS + RT (3.9%), but there was little change in the difference by age (50 years: 0.9% versus 80 years: 1.2%). The results highlight the change in baseline mortality risk by age for OS compared to the stable baseline for BCSS.For OS, the difference in survival probabilities for BCS + RT and mastectomy increased slightly with age. The difference in cumulative incidence functions for breast cancer death by surgery type was small regardless of age. Evidence on real-world survival outcomes among older populations with breast cancer is informative for treatment decision-making.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.