Outcomes After Mastectomy and Lumpectomy in Elderly Patients with Early-Stage Breast Cancer
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Survival in elderly patients undergoing mastectomy or lumpectomy has not been specifically analyzed.
Patients older than 70 years of age with clinical stage I invasive breast cancer, undergoing mastectomy or lumpectomy with or without radiation, and surveyed within 3 years of their diagnosis, were identified from the Surveillance, Epidemiology, and End Results and medicare health outcomes survey-linked dataset. The primary endpoint was breast cancer-specific survival (CSS).
Of 1784 patients, 596 (33.4 %) underwent mastectomy, 918 (51.4 %) underwent lumpectomy with radiation, and 270 (15.1 %) underwent lumpectomy alone. Significant differences were noted in age, tumor size, American Joint Committee on Cancer (AJCC) stage, lymph node status (all p < 0.0001) and number of positive lymph nodes between the three groups (p = 0.003). On univariate analysis, CSS for patients undergoing lumpectomy with radiation [hazard ratio (HR) 0.61, 95 % confidence interval (CI) 0.43–0.85; p = 0.004] was superior to mastectomy. Older age (HR 1.3, 95 % CI 1.09–1.45; p = 0.002), two or more comorbidities (HR 1.57, 95 % CI 1.08–2.26; p = 0.02), inability to perform more than two activities of daily living (HR 1.61, 95 % CI 1.06–2.44; p = 0.03), larger tumor size (HR 2.36, 95 % CI 1.85–3.02; p < 0.0001), and positive lymph nodes (HR 2.83, 95 % CI 1.98–4.04; p < 0.0001) were associated with worse CSS. On multivariate analysis, larger tumor size (HR 1.89, 95 % CI 1.37–2.57; p < 0.0001) and positive lymph node status (HR 1.99, 95 % CI 1.36–2.9; p = 0.0004) independently predicted worse survival.
Elderly patients with early-stage invasive breast cancer undergoing breast conservation have better CSS than those undergoing mastectomy. After adjusting for comorbidities and functional status, survival is dependent on tumor-specific variables. Determination of lymph node status remains important in staging elderly breast cancer patients.
KeywordsBreast Cancer Overall Survival Sentinel Node Biopsy Invasive Lobular Carcinoma Positive Lymph Node Status
This study was supported by Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.
Conflicts of interest
Harveshp D. Mogal, Clancy Clark, Rebecca Dodson, Nora F. Fino, and Marissa Howard-McNatt have no conflicts of interest to declare.
Institutional Review Board approval was obtained for this study.
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