Treatment and survival outcomes in older women with primary breast cancer: A retrospective propensity score-matched analysis
Yuting Sang,
Benlong Yang,
Miao Mo,
Shiyang Liu,
Xujie Zhou,
Jiajian Chen,
Shuang Hao,
Xiaoyan Huang,
Guangyu Liu,
Zhimin Shao,
Jiong Wu
Affiliations
Yuting Sang
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, 200032, China
Benlong Yang
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
Miao Mo
Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Shiyang Liu
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, 200032, China
Xujie Zhou
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, 200032, China
Jiajian Chen
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
Shuang Hao
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
Xiaoyan Huang
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
Guangyu Liu
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, 200032, China
Zhimin Shao
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, 200032, China
Jiong Wu
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, 200032, China; Corresponding author. Department of Breast Surgery, Breast Cancer Institute, Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.
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.
