by Yuting Sang, Benlong Yang, Miao Mo, Shiyang Liu, Xujie
Zhou, Jiajian Chen, Shuang Hao, Xiaoyan Huang, Guangyu Liu, Zhimin Shao, Jiong Wu
The Breast: September 06, 2022
Purpose
Changes in biological features and functional status make
management decisions in older women with primary breast cancer complicated. We
aimed to provide an overview of the clinicopathological characteristics and
survival outcomes of older breast cancer patients based on the current
treatment strategies.
Methods
Female patients diagnosed with primary invasive breast
cancer at Fudan University Shanghai Cancer Centre from 2008 to 2016 were
included. Patients were divided into a younger group (<65 years) and older
group (≥65 years). Propensity score matching was utilised to generate balanced
cohorts.
Results
A total of 13,707 patients met the study criteria. Compared
with younger patients, older patients had a higher Charlson Comorbidity Index
(p < 0.001), less lymph node metastasis (p = 0.009),
more advanced tumour stage (p = 0.038), and a larger proportion of
estrogen receptor-positive (p < 0.001) and epidermal growth factor
receptor 2-negative (p < 0.001) tumours. Older patients were
likely to receive mastectomy and axillary lymph node dissection in addition to
a lower proportion of adjuvant chemotherapy. Adjuvant chemotherapy (HR [hazard
ratio] 0.69, p = 0.039) was independently correlated with better
overall survival in the older patients. This survival benefit (HR 0.58,
p = 0.041) was confirmed in matched cohorts. Among the older patients
with larger tumours (HR 0.48, p = 0.038) and more lymph node
involvement (HR 0.44, p = 0.040), adjuvant chemotherapy was
associated with a significant survival benefit.
Conclusion
Older breast cancer patients showed less aggressive
biological characteristics, intensive surgical and moderate medical
preferences. The addition of adjuvant chemotherapy should be considered for
older patients, especially for patients with large tumours and more lymph node
involvement.
