Breast cancer in the oldest old (≥ 89 years): Tumor characteristics, treatment choices, clinical outcomes and literature review

Lascio, Simona Di; Tognazzo, Enrico; Bigiotti, Sara; Biedka, Marta; Costa, Alberto; Pagani, Olivia; Meani, Francesco

doi:10.1016/j.ejso.2020.10.008

Cited by 7 publications

(7 citation statements)

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“…In this population, the expression level of estrogen receptor (ER) and progesterone receptor (PR) is high, and the overexpression rate of human epidermal growth factor receptor 2 (HER2) is low. In addition, early axillary lymph node (ALN) metastasis is less frequent in elderly patients (4)(5)(6)(7). At present, the treatment strategy of elderly breast cancer is still based on the reference of young patients, and there are no specific diagnostic and treatment standards for elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Local and systemic therapy may be safely de-escalated in elderly breast cancer patients in China: A retrospective cohort study

Zhong

et al. 2022

Front. Oncol.

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BackgroundFor elderly patients with breast cancer, the treatment strategy is still controversial. In China, preoperative axillary lymph node needle biopsy is not widely used, resulting in many patients receiving axillary lymph node dissection (ALND) directly. Our study aims to determine whether local and systemic therapy can be safely de-escalated in elderly breast cancer.MethodsPatients aged ≥70 years were retrospectively enrolled from our institution’s medical records between May 2013 and July 2021. Groups were assigned according to local and systemic treatment regimens, and stratified analysis was performed by molecular subtypes. Univariate and multivariate survival analyses were used to compare the effects of different regimens on relapse-free survival (RFS).ResultsA total of 653 patients were enrolled for preliminary data analysis, and 563 patients were screened for survival analysis. The mean follow-up was 19 months (range, 1–82 months). Axillary lymph node metastases were pathologically confirmed in only 2.1% of cN0 cases and up to 97.1% of cN+ cases. In the aspect of breast surgery, RFS showed no significant difference between mastectomy and BCS group (p = 0.3078). As for axillary surgery, patients in the ALND group showed significantly better RFS than those in the sentinel lymph node biopsy (SLNB) group among pN0 patients (p = 0.0128). Among these cases, the proportion of cN+ in ALND was significantly higher than that in SLNB (6.4% vs. 0.4%, p = 0.002), which meant axillary lymph nodes (ALNs) of ALND patients were larger in imaging and more likely to be misdiagnosed as metastatic. With regard to adjuvant therapy, univariate and multivariate analyses showed that RFS in different comprehensive adjuvant regimens were similar especially among hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− subgroup where patients who did not receive any adjuvant therapy accounted for 15.7% (p > 0.05).ConclusionsIt is feasible to reduce some unnecessary local or systemic treatments for elderly breast cancer patients, especially in HR+/HER2− subtype. Multiple patient-related factors should be considered when making treatment plans.

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Section: Introductionmentioning

confidence: 99%

Local and systemic therapy may be safely de-escalated in elderly breast cancer patients in China: A retrospective cohort study

Zhong

et al. 2022

Front. Oncol.

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“…With the aging process, an increasing number of older women would be diagnosed with breast cancer and many are diagnosed at stages requiring more aggressive treatment, which needs efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments that could help improve postoperative survival while preserving the quality of life ( 6 , 21 , 26 , 28 , 30 ). Currently, many clinical trials have demonstrated that elderly women with TNBC had the worst outcome when compared with other subtypes of breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, many well-designed trials and comprehensive reviews demonstrated that adjuvant chemotherapy and radiotherapy are effective at reducing TNBC recurrences and associated with better cancer-specific survival (CSS) and OS in early-stage or younger TNBC patients ( 11 , 15 – 19 ). Nevertheless, evidence-based data on the best treatment approach to the elderly patient group are mostly lacking, partly owing to the underrepresentation of elderly patients in clinical studies ( 9 , 20 , 21 ). Moreover, the favorable role of adjuvant chemotherapy in promoting postoperative survival in elderly TNBC patients is still in conflict, with most studies limited to subgroup analyses or small retrospective studies ( 21 – 23 ).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, evidence-based data on the best treatment approach to the elderly patient group are mostly lacking, partly owing to the underrepresentation of elderly patients in clinical studies ( 9 , 20 , 21 ). Moreover, the favorable role of adjuvant chemotherapy in promoting postoperative survival in elderly TNBC patients is still in conflict, with most studies limited to subgroup analyses or small retrospective studies ( 21 – 23 ).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

Tang

Min

et al. 2022

Front. Endocrinol.

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BackgroundTriple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. In the elderly (≥70 years old) primary operable (T1-3N0-1M0) TNBC, individualized treatment modalities for this population are pivotal and important, but limited studies are explored.MethodsThe clinicopathological features of elderly primary operable TNBC patients were retrospectively selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015. Kaplan–Meier curves were used to show the survival patterns in the different subgroups. Multivariate Cox analysis was used to identify independent risk factors in the 3-, 5-, and 7- year overall survival (OS) and cancer-specific survival (CSS) in this subpopulation. The predictive model was further developed and validated for clinical use.ResultBetween 2010 and 2015 years, a total of 4,761 elderly primary operable TNBC patients were enrolled for the study, with a mean age of 76 years and a median follow-up of 56 months. The multivariate Cox analysis showed that age (increased per year: hazard ratio (HR) = 1.05), race (Asian/Pacific Islander and American Indian/Alaska Native, HR = 0.73), differentiation grade (grade II: HR = 2.01; grade III/IV: HR = 2.67), larger tumor size (T1c: HR = 1.83; T2: HR = 2.78; T3: HR = 4.93), positive N stage (N1mi: HR = 1.60; N1: HR = 1.54), receiving radiation therapy (HR = 0.66), and receiving adjuvant chemotherapy (HR = 0.61) were the independent prognostic factors for OS, and a similar prognostic pattern was also determined in CSS. Besides, two nomograms for predicting the 3-, 5-, and 7-year OS and CSS in this population were developed with a favorable concordance index of 0.716 and 0.746, respectively.ConclusionThe results highlight that both radiation and adjuvant chemotherapy are significantly associated with favorable long-term OS and CSS probability in elderly primary operable TNBC patients. Based on the determined independent prognostic factors, the novel nomograms could assist the oncologists to make individualized clinical decisions for the subpopulation at different risks.

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“…Studies have shown that breast cancer patients with a younger age are more likely to develop malignancy and have a poor prognosis [20,21]. Although older women have inert tumors in breast cancer [22], they have a poor prognosis of breast cancer under treatment or overtreatment [23]. Therefore, breast cancer prognosis has been controversial based on the age at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Age has a U-shaped Relationship with Breast Cancer Outcomes in Women

Xie

Wei

Huang

et al. 2022

Preprint

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Background and Objectives There is insufficient information available on how breast cancer prognosis is affected by age at diagnosis. Our study aimed to examine the association between age at diagnosis and overall survival (OS), breast cancer-specific survival (BCSS) and disease-free survival (DFS) rates. Methods 1054 breast cancer patients were obtained in our retrospective cohort study from March 7, 2013 to December 31, 2019. Patients were dividedinto four groups based on their age. Different age groups were described using the Kaplan-Meier method for OS, BCSS and DFS survival rates. A model of Cox proportional hazards ratio (HR) with restricted cubic splines (RCS) and smooth curve fitting were usedto estimate 95% confidence interval (CI) and hazard ratios (HRs) of OS, BCSS and DFS rates. Results 71 patients (6.74%) died and 144 patients (13.66%) recurred during a median follow-up of 4.86 years. Quarter 2 showed the best OS, BCSS, and DFS rates in the Kaplan-Meier survival analysis. The outcomes of RCS analysis indicated that there was a U-shaped relationship between the age and OS, BCSS and DFS rates despite after adjustment for other confounding factors, the inflection points of OS, BCSS and DFS rates were 44years, 37years and 41years. Conclusions In Asian women, there is a U-shaped association between age at diagnosis and breast cancer outcomes.

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Breast cancer in the oldest old (≥ 89 years): Tumor characteristics, treatment choices, clinical outcomes and literature review

Cited by 7 publications

References 65 publications

Local and systemic therapy may be safely de-escalated in elderly breast cancer patients in China: A retrospective cohort study

Local and systemic therapy may be safely de-escalated in elderly breast cancer patients in China: A retrospective cohort study

Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

Age has a U-shaped Relationship with Breast Cancer Outcomes in Women

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