Operation with less adjuvant therapy for elderly breast cancer

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• 作者：Akimitsu Yamada ; MD ; PhD^a ; ^{yakimitsu@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kazutaka Narui ; MD ; PhD^a ; Sadatoshi Sugae ; MD ; PhD^b ; Daisuke Shimizu ; MD ; PhD^c ; Kazuaki Takabe ; MD ; PhD^d ; Yasushi Ichikawa ; MD ; PhD^e ; Takashi Ishikawa ; MD ; PhD^f ; Itaru Endo ; MD ; PhD^b
• 关键词：Breast cancer ; Elderly ; Surgery ; Radiotherapy ; Systemic therapy ; Prognosis
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：204
• 期：2
• 页码：410-417
• 全文大小：823 K

文摘

The standard of care for elderly women with breast cancer remains controversial. The aim of this study was to clarify the management of elderly breast cancer patients who undergo surgery.

Materials and methods

This retrospective single-center cohort study included 2276 breast cancer patients who underwent surgery between 1993 and 2014. The patients were divided into three groups according to age: ≤64 y (young), 65-74 y (older), and ≥75 y (elderly).

Results

The elderly had more advanced stage disease at diagnosis (stage III and IV, 16.2%, 17.5%, and 22.1% for the young, older, and elderly groups, respectively). The elderly were more likely to undergo mastectomy (43.3%, 41.4%, and 50.7%, respectively), omit axillary operation (0.6%, 1.1%, and 9.3%, respectively), and skip radiotherapy after breast-conserving surgery (93.1%, 86.8%, and 29.1%, respectively). Endocrine therapy was widely used in all the groups (94.4%, 93.8%, and 90.1%, respectively), but frequency of chemotherapy was lower in the elderly regardless of hormone receptor (HR) status (40.8%, 25.5%, and 9.3% in HR(+), 87.2%, 75.3%, and 39.5% in HR(−), respectively). Although the locoregional recurrence rate was higher in the elderly (4.2%, 3.4%, and 7.0% at 5 y, respectively; P = 0.028), there were no differences among groups in distant metastasis–free survival or breast cancer–specific survival.

Conclusions

Although elderly patients had more advanced stages of cancer and received less treatment, there were no differences in survival. Omission of axillary dissection, radiation, and chemotherapy after operation may be an option for breast cancer patients aged ≥75 y.