Do elderly breast cancer patients have poorer survival outcome

Abstract

Aim: This study is to compare breast cancer in elderly patients to their younger counterparts, and to look for factors affecting the survival of elderly patients. Methods: A retrospective study of breast cancer patients who have undergone surgery in a university hospital from January 2000 to December 2015 was performed. Stage on presentation, tumor characteristics and modalities of treatment for patients aged 70 and above were compared with those aged below 70. Factors affecting the overall survival were assessed by multivariate cox regression. Results: 3825 patients with breast cancer underwent surgery during the study period. 510 patients (13.3%) were aged 70 and above. Elderly patients presented with tumors larger in size (p=0.002) and less HER-2 oncogene overexpression (p=0.007). More elderly patients had mastectomy (p=0.000), neoadjuvant (p=0.000) and adjuvant hormonal therapy (p=0.001). Elderly patients received less adjuvant radiotherapy (p=0.000), neoadjuvant (p=0.000) and adjuvant chemotherapy (p=0.000). The 5 year overall survival for elderly patients is 76.9%, which is poorer than their younger counterparts 89.5% (p=0.000). By multivariate analysis, adjuvant hormonal therapy (p=0.001, HR 0.564), T3 (p=0.014, HR 3.169), T4 (p=0.004, HR 3.877), N2 (p<0.001, HR 2.655) and N3 (p=0.003, HR 2.224) were the independent factors affecting the overall survival in elderly patients. Conclusion: Elderly breast cancer patients had worse survival. Stage on presentation and use of adjuvant hormonal therapy are independent factors affecting the survival in elderly patients. Early diagnosis and comprehensive geriatric assessment to guide the optimal treatment plan would be useful for better survival outcome in elderly breast cancer patients.