Overall survival of elderly patients with breast cancer is not related to breast-cancer specific survival: A single institution experience in Japan

Takuwa, Haruko; Tsuji, Wakako; Yotsumoto, Fumiaki

doi:10.3233/bd-170280

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…This was contradictory to a metaanalysis conducted by Cappellani et al 2013 that showed the same treatment outcome in elder patients as youngers ones with standard treatment, however some old women with early stage may receive less therapy [17]. In addition, another study done in Japan comparing breast cancer patients in the 70s with those in the 80s and above revealed that the standard treatment was the main factor minimizing recurrence and distant metastasis [18]. Another study done in metastatic elderly patients showed that performance status and comorbidity were the main factors leading do under treatment in patients above 75 years [19].…”

Section: Discussionmentioning

confidence: 81%

Clinico-Epidemiological Study of Elderly Breast Cancer in a Developing Country: Egypt

Ibrahim¹

2019

JCTR

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Context: The prognosis and treatment outcome in elderly breast cancer is not well known. Aim: To study the prognosis and treatment outcome in elderly breast cancer. Methods and materials: This a retrospective study of breast cancer patients' ≥70years in the period from January 2005 until December 2010 in Egypt. Kaplan Meir overall survival (OS) analysis and disease-free survival (DFS) were done and they were correlated with different prognostic factors. Results: Among 186 old patients, 139 one were analyzed. The median age was 73.4 years at diagnosis with a mean of 75. Most patients (70.4%) were in the range of 70-74 from urban areas (89.2%) with performance status 1-2 (90.6%) and with ≤ 2 co-morbidity (67.6%). Stage III and IV presented 43.9%. Positive ER and PR was 83.4% and 75.5% respectively. Surgery was done in 77.7% of cases with 62.6% modified radical mastectomy and 15.1% conservative lumpectomy and axillary clearance. Treatment included mostly hormonal treatment (79.9%), radiotherapy (47.5%) and lastly chemotherapy (18.7%). The 5-year OS and DFS were 52% and 53.4% respectively. The median progression free survival (PFS) in metastatic patients was 4 months. The DFS was significantly affected by performance status (PS), tumor stage, and presence of metastasis. (P-value = 0.018, <0.001, 0.003 respectively). Conclusion: the 5-year OS was lower than the developed country. The majority of deaths (55.7%) were not related to breast cancer. Primary tumor stage and metastasis were significant prognostic factor for DFS.

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Section: Discussionmentioning

confidence: 81%

Clinico-Epidemiological Study of Elderly Breast Cancer in a Developing Country: Egypt

Ibrahim¹

2019

JCTR

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“…Deaths not connected with cancer were more common, in comparison with other causes. Standard multidisciplinary treatment for BC prevents recurrence and metastasis and tends to extend breast CSS even in older patients [27].…”

Section: Discussionmentioning

confidence: 99%

Breast cancer in women aged 75 years and older – tumour characteristics and treatment options

Kędzierawski¹,

Mężyk

2021

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Introduction: An optimal approach to older women with breast cancer is still a major challenge. In this paper, we present a retrospective analysis of treatment in patients aged 75 years and older who were treated at the Holycross Cancer Centre in 2015-2019. Material and methods: The analysed group consisted of 259 women. For estimation of the general status of patients, we used the Geriatric 8 questionnaire. For every patient, an individual treatment plan was established. Survival analysis was performed; disease-free survival (DFS), cancer-specific survival, and overall survival (OS) were calculated by the Kaplan-Meier method. For DFS and OS, the Cox proportional-hazard regression was applied. Results: The mean age in the analysed group was 80 years. Stage I and II cancer accounted for over 80% of patients. Radical mastectomy was performed in 56% and breast-conserving surgery in over 34% of patients. Sentinel lymph node biopsy was used in 114 patients. Preoperative systemic treatment was applied in 34 and postoperative chemotherapy in 51 patients, respectively. Trastuzumab was used in 23 patients. Postoperative hormonal therapy was applied in 205 and radiotherapy in 178 patients. During the observation after the treatment 32 patients died, while 227 survived. In multivariate analysis for DFS hormonotherapy was statistically significant for OS clinical stage and hormonotherapy. Conclusions: The treatment plan for older women consisted of surgery and radiation therapy, and systemic treatment should be always considered. The decision should be made by the breast cancer team.

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“…16 These findings were mirrored in recent data published from Japan in which OS was significantly worse with increasing age, however breast cancer specific survival (BCSS) was not, indicating comorbidities are contributing to mortality at a greater rate than breast cancer recurrence in elderly women. 17 This is especially important to keep in mind when considering adjuvant therapies that can be associated with significant complications. Given the heterogeneity in the health status of older patients and increased rates of comorbidities, treatment decisions must be individualized in order to deliver the best possible care to this population.…”

Section: Discussionmentioning

confidence: 99%

Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx

Lee

Switchenko

et al. 2019

Ann Surg Oncol

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Background. Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aimed to determine how women ≥ 70 years with intermediate RS were redistributed post-TAILORx and to identify predictors of low RS. Methods. Patients ≥ 70 years with early-stage, node-negative, ER-positive breast cancers in the National Cancer Database(2006–2014) were included. “Pre-TAILORx” RS were classified as low (0–17), intermediate (18–30), and high (> 30). “Post-TAILORx” RS were classified as low (0–25) and high (> 25). Results. In total, 14,925 women were included. Average age was 74 years. 60% (n = 9009) had low pre-TAILORx RS, 31% (n = 4635) intermediate, and 9% (n = 1281) high. Of 4635 patients with intermediate RS, 72% (n = 3660) were reclassified to low RS. Only 12% (n = 1783) of patients received chemotherapy. Of patients with pre-TAILORx intermediate RS who received chemotherapy, 55% (n = 417) would have been spared chemotherapy by being reclassified with low RS post-TAILORx. The strongest predictor of post-TAILORx low RS was tumor grade; 95% of well-differentiated had low RS, compared with 56% of poorly/undifferentiated tumors (p < 0.001). Smaller tumor size also was associated with low RS. Age was not associated with RS. Conclusions. With post-TAILORx RS criteria, the vast majority of patients ≥ 70 years can be classified as low-risk and unlikely to benefit from chemotherapy. Given that the elderly have greater rates of chemotherapy-associated complications, reconsideration of routine RS testing in patients ≥ 70 years is warranted. Tumor grade and size also may inform the decision to omit RS testing.

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Overall survival of elderly patients with breast cancer is not related to breast-cancer specific survival: A single institution experience in Japan

Abstract: Standard multidisciplinary treatment for breast cancer prevents recurrence and metastasis and tends to extend breast cancer-specific survival even in elderly patients.

Cited by 11 publications

References 14 publications

Clinico-Epidemiological Study of Elderly Breast Cancer in a Developing Country: Egypt

Clinico-Epidemiological Study of Elderly Breast Cancer in a Developing Country: Egypt

Breast cancer in women aged 75 years and older – tumour characteristics and treatment options

Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx

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