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

• DOI: 10.1186/s12885-021-07947-w
• Publication Date: 2021-03-05T05:02:24Z
• Authors: Xu Liu; Dan Zheng; Yanqi Wu; Chuanxu Luo; Yu Fan; Xiaorong Zhong; Hong Zheng
• Keywords: China; Antineoplastic Agents, Hormonal; Breast Neoplasms; Adjuvant therapy; Disease-Free Survival; 03 medical and health sciences; Breast cancer; Antineoplastic Agents, Immunological; 0302 clinical medicine; Humans; Overall survival; Elderly women; Breast; Practice Patterns, Physicians'; RC254-282; Mastectomy; Aged; Neoplasm Staging; Aged, 80 and over; Age Factors; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; Trastuzumab; Prognosis; 3. Good health; Chemotherapy, Adjuvant; Female; Radiotherapy, Adjuvant; Neoplasm Recurrence, Local; Research Article; Follow-Up Studies

Abstract 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.