Clinicopathologic Features and Long-Term Outcomes of Elderly Breast Cancer Patients: Experiences at a Single Institution in Korea
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Purpose The purpose of this study was to assess the tumor characteristics and long-term clinical outcomes of adjuvant treatments after surgery with a curative aim for patients with breast cancer who are 65 years and older. Materials and Methods Patients with breast cancer who underwent curative surgery from 2000 to 2009 were analyzed (n=4,388). Tumor characteristics and survival outcome were compared by dividing the patients into two age groups (< 65 and 65 years old). The Kaplan-Meier method was used for comparison of survival rates by log-rank test, and a Cox regression model was used to examine the effect of variables. Results Among 4,388 patients with invasive breast cancer, 317 patients (7.2%) were 65 years or older and the median age of all patients was 47 years (range, 18 to 91 years). Tumor characteristics were similar between the two age groups, but the older patients were treated less often with adjuvant treatments. During a median follow-up period of 122 months, recurrence-free survival (RFS) was equivalent for patients 65 years and older compared to younger patients, but significantly worse in overall survival (OS) and breast cancer–specific survival (BCSS) (5-year OS, 94.3% vs. 90.5%; p < 0.001 and 5-year BCSS, 94.7% vs. 91.8%; p=0.031). In the multivariate model, age 65 years old was identified as an independent risk factor for OS and RFS. Conclusion Elderly breast cancer appeared to have worse outcomes with very low prevalence in Korea, despite similar tumor characteristics. More active adjuvant therapies would have a role for aggressive subtypes for fit, elderly patients.
Abstract
Purpose The purpose of this study was to assess the tumor characteristics and long-term clinical outcomes of adjuvant treatments after surgery with a curative aim for patients with breast cancer who are 65 years and older. Materials and Methods Patients with breast cancer who underwent curative surgery from 2000 to 2009 were analyzed (n=4,388). Tumor characteristics and survival outcome were compared by dividing the patients into two age groups (< 65 and 65 years old). The Kaplan-Meier method was used for comparison of survival rates by log-rank test, and a Cox regression model was used to examine the effect of variables. Results Among 4,388 patients with invasive breast cancer, 317 patients (7.2%) were 65 years or older and the median age of all patients was 47 years (range, 18 to 91 years). Tumor characteristics were similar between the two age groups, but the older patients were treated less often with adjuvant treatments. During a median follow-up period of 122 months, recurrence-free survival (RFS) was equivalent for patients 65 years and older compared to younger patients, but significantly worse in overall survival (OS) and breast cancer–specific survival (BCSS) (5-year OS, 94.3% vs. 90.5%; p < 0.001 and 5-year BCSS, 94.7% vs. 91.8%; p=0.031). In the multivariate model, age 65 years old was identified as an independent risk factor for OS and RFS. Conclusion Elderly breast cancer appeared to have worse outcomes with very low prevalence in Korea, despite similar tumor characteristics. More active adjuvant therapies would have a role for aggressive subtypes for fit, elderly patients.
참고문헌 (23)
- Yancik R, "Cancer burden in the aged : an epidemiologic and demographic overview", Cancer, 80, pp.1273~1283 (1997)
- "2015 Statistical report on the aged" (2015)[URL]
- Ferlay J, "Estimates of worldwide burden of cancer in 2008 : GLOBOCAN 2008", Int J Cancer, 127, pp.2893~2917 (2010)
- Han W, "Young age : an independent risk factor for disease-free survival in women with operable breast cancer", BMC Cancer, 4, pp.82~ (2004)
- Ko SS, "Chronological changing patterns of clinical characteristics of Korean breast cancer patients during 10 years (1996-2006) using nationwide breast cancer registration on-line program: biannual update", J Surg Oncol, 98, pp.318~323 (2008)
- Leong SP, "Is breast cancer the same disease in Asian and Western countries?", World J Surg, 34, pp.2308~2324 (2010)
- "2012 Report on the statistics for national cancer incidence" (2015)[URL]
- Goodwin JS, "Cancer treatment protocols : who gets chosen?", Arch Intern Med, 148, pp.2258~2260 (1988)
- Yancik R, "Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older", JAMA, 285, pp.885~892 (2001)
- Clark GM, "The biology of breast cancer in older women", J Gerontol, 47, pp.19~23 (1992)
- Karuturi M, "Approach and management of breast cancer in the elderly", Clin Geriatr Med, 32, pp.133~153 (2016)
- Mislang AR, "Adjuvant systemic therapy in older breast cancer women: can we optimize the level of care?", Cancers (Basel), 7, pp.1191~1214 (2015)
- Biganzoli L, "Management of elderly patients with breast cancer:updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA)", Lancet Oncol, 13, pp.148~160 (2012)
- Bouchardy C, "Undertreatment strongly decreases prognosis of breast cancer in elderly women", J Clin Oncol, 21, pp.3580~3587 (2003)
- Tew WP, "Breast and ovarian cancer in the older woman", J Clin Oncol, 32, pp.2553~2561 (2014)
- Diab SG, "Tumor characteristics and clinical outcome of elderly women with breast cancer", J Natl Cancer Inst, 92, pp.550~556 (2000)
- Lawson JS, "Low oestrogen receptor alpha expression in normal breast tissue underlies low breast cancer incidence in Japan", Lancet, 354, pp.1787~1788 (1999)
- Bouchardy C, "Older female cancer patients : importance, causes, and consequences of undertreatment", J Clin Oncol, 25, pp.1858~1869 (2007)
- Dore M, "Hypofractionated irradiation in elderly patients with breast cancer after breast conserving surgery and mastectomy : analysis of 205cases", Radiat Oncol, 10, pp.161~ (2015)
- Du XL, "Comparative effectiveness of chemotherapy regimens in prolonging survival for two large population-based cohorts of elderly adults with breast and colon cancer in 1992-2009", J Am Geriatr Soc, 63, pp.1570~1582 (2015)
- Muss HB, "Adjuvant chemotherapy in older women with early-stage breast cancer", N Engl J Med, 360, pp.2055~2065 (2009)
- Klepin H, "Geriatric assessment in older patients with breast cancer", J Natl Compr Canc Netw, 7, pp.226~236 (2009)
- Caillet P, "Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer : ELCAPA study", J Clin Oncol, 29, pp.3636~3642 (2011)