Surgical treatment and prognosis of breast cancer in elderly – A population-based study

Ojala, Kaisu; Meretoja, Tuomo J.; Mattson, Johanna; Leidenius, Marjut

doi:10.1016/j.ejso.2019.01.019

Cited by 16 publications

(17 citation statements)

References 32 publications

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“…Of the patients who did not receive surgery, 78.4% received chemotherapy. Moreover, survival benefit of surgical treatment in patients older than 80 years have also been confirmed in another study [ 27 ], and surgical treatment was safe in older patients.…”

Section: Discussionmentioning

confidence: 64%

Treatment patterns and outcomes in older women with early breast cancer: a population-based cohort study in China

Liu

Zheng

et al. 2021

BMC Cancer

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Background Despite the proportion of elderly breast cancer patients has been consistently increasing, the optimal treatment modalities for this population have not been well explored. We summarized the treatment outcomes of these patients in our hospital. Methods Older patients with early breast cancer were identified from the Breast Cancer Information Management System at West China Hospital, Sichuan University (2000–2019). We compared tumor characteristics and treatment outcomes between the older group (65–74 years old) and the elderly group (≥75 years old). The Kaplan-Meier and Cox regression analysis were conducted to determine significant prognostic factors. Results In total, 1094 patients were included. The median follow-up time for this cohort was 59 months. The majority of patients underwent surgery and benefited from surgical treatment. Elderly group patients were less likely to receive adjuvant chemotherapy or postmastectomy radiotherapy (PMRT) compared to the older group. However, adjuvant chemotherapy was associated with improved overall survival (OS) (hazard ratio [HR] 0.521, 95% confidence interval [CI] 0.284–0.955, P = 0.035). Subgroup analysis revealed that patients with grade III disease best benefited from adjuvant chemotherapy. PMRT offered a significant improvement in local disease control, but not in OS. Furthermore, endocrine therapy improved the OS of HR-positive patients (HR 0.440, 95%CI 0.261–0.741, P = 0.002), especially for cases aged 65–74 years. Also, receipt of trastuzumab in HER2-positive patients was associated with better OS (HR 0.168, 95%CI 0.029–0.958, P = 0.045). Conclusions Our findings suggest that surgery, adjuvant chemotherapy, endocrine and targeted therapy are associated with improved OS in older breast cancer patients. Moreover, clinicopathological characteristics should be comprehensively considered when making treatment decisions for these patients.

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Section: Discussionmentioning

confidence: 64%

Treatment patterns and outcomes in older women with early breast cancer: a population-based cohort study in China

Liu

Zheng

et al. 2021

BMC Cancer

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“…Of the patients who did not receive surgery, 78.4% received chemotherapy. Moreover, survival bene t of surgical treatment in patients older than 80 years have also been con rmed in another study, (27) and surgical treatment was safe in older patients.…”

Section: Discussionmentioning

confidence: 70%

Treatment Patterns and Outcomes in Older Women with Early Breast Cancer: A Population-Based Cohort Study in China

Liu

Zheng

et al. 2020

Preprint

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Background: Despite the proportion of elderly breast cancer patients has been consistently increasing, the optimal treatment modalities for this population have not been well explored. We summarized the treatment outcomes of these patients in our hospital.Methods: Older patients with early breast cancer were identified from the Breast Cancer Information Management System at West China Hospital, Sichuan University (2000-2019). We compared tumor characteristics and treatment outcomes between the control group (65-74 years old) and the elderly group (≥75 years old). The Kaplan-Meier and Cox regression analysis were conducted to determine significant prognostic factors.Results: In total, 1094 patients were included. The median follow-up time for this cohort was 59 months. The majority of patients underwent surgery and benefited from surgical treatment. Elderly group patients were less likely to receive adjuvant chemotherapy or postmastectomy radiotherapy (PMRT) compared to the control group. However, adjuvant chemotherapy was associated with improved overall survival (OS) (hazard ratio [HR] 0.521, 95% confidence interval [CI] 0.284-0.955, P=0.035). Subgroup analysis revealed that patients with grade III disease best benefited from adjuvant chemotherapy. PMRT offered a significant improvement in local disease control, but not in OS. Furthermore, endocrine therapy improved the OS of HR-positive patients (HR 0.440, 95%CI 0.261-0.741, P=0.002), especially for cases aged 65-74 years. Also, receipt of trastuzumab in HER2-positive patients was associated with better OS (HR 0.168, 95%CI 0.029-0.958, P=0.045).Conclusions: Our findings suggest that surgery, adjuvant chemotherapy, endocrine and targeted therapy are associated with improved OS in older breast cancer patients. Moreover, clinicopathological characteristics should be comprehensively considered when making treatment decisions for these patients.

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“…Van de Glas et al showed that the proportion of older BC patients that did not receive breast surgery increased substantially from 9.2% in 1995 to 30.1% in 2011 [17]. Moreover, previous population-based studies showed that the proportion of older BC patients receiving primary endocrine therapy is higher in the Netherlands than in other European countries [22,23,24]. The EUROCARE breast cancer group found lower survival rates in European countries, like England and Ireland, where older BC patients are treated more often with primary endocrine therapy omitted [22].…”

Section: Discussionmentioning

confidence: 99%

Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

Abbema

Vissers

Vos‐Geelen

et al. 2019

Cancers

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Previous studies showed substantial improvement of survival rates in patients with cancer in the last two decades. However, lower survival rates have been reported for older patients compared to younger patients. In this population-based study, we analyzed treatment patterns and the survival of patients with breast cancer (BC) and colorectal cancer (CRC). Patients with stages I–III BC and CRC and diagnosed between 2003 and 2012 were selected from the Netherlands Cancer Registry (NCR). Trends in treatment modalities were evaluated with the Cochran-Armitage trend test. Trends in five-year overall survival were calculated with the Cox hazard regression model. The Ederer II method was used to calculate the five-year relative survival. The relative excess risk of death (RER) was estimated using a multivariate generalized linear model. During the study period, 98% of BC patients aged <75 years underwent surgery, whereas for patients ≥75 years, rates were 79.3% in 2003 and 66.7% in 2012 (p < 0.001). Most CRC patients underwent surgery irrespective of age or time period, although patients with rectal cancer aged ≥75 years received less surgery or radiotherapy over the entire study period than younger patients. The administration of adjuvant chemotherapy increased over time for CRC and BC patients, except for BC patients aged ≥75 years. The five-year relative survival improved only in younger BC patients (adjusted RER 0.95–0.96 per year), and was lower for older BC patients (adjusted RER 1.00, 95% Confidence Interval (CI) 0.98–1.02, and RER 1.00; 95% CI 0.98–1.01 per year for 65–74 years and ≥75 years, respectively). For CRC patients, the five-year relative survival improved over time for all ages (adjusted RER on average was 0.95 per year). In conclusion, the observed survival trends in BC and CRC patients suggest advances in cancer treatment, but with striking differences in survival between older and younger patients, particularly for BC patients.

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Surgical treatment and prognosis of breast cancer in elderly – A population-based study

Cited by 16 publications

References 32 publications

Treatment patterns and outcomes in older women with early breast cancer: a population-based cohort study in China

Treatment patterns and outcomes in older women with early breast cancer: a population-based cohort study in China

Treatment Patterns and Outcomes in Older Women with Early Breast Cancer: A Population-Based Cohort Study in China

Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

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