The timing of surgery for elderly patients with locally advanced breast cancer

Older patients have poor tolerance to chemotherapy, and the timing of surgical treatment for elderly patients with locally advanced breast cancer is unclear. The objective of this study was to evaluate the long-term survival characteristics of elderly patients with locally advanced breast cancer and the timing of surgery.

Data from the Surveillance, Epidemiology, and End Results (SEER) database were used to explore the timing of surgery in locally advanced elderly breast cancer patients diagnosed between 2010 and 2015. The study population was 70 years of age or older and had a tumor-node-metastasis (TNM) stage of T3-4N0-3M0. Patients were divided into upfront surgery and neoadjuvant therapy (NAT). Overall survival (OS) was evaluated with Kaplan-Meier analysis (using the log-rank test) and multivariate Cox proportional hazards modeling. Survival outcomes were compared between the upfront surgery group and the neoadjuvant therapy group and subgroup comparisons of survival outcomes were performed. Propensity score matching (PSM) was used to match the variables between the two groups.

A total of 2,191 patients with locally advanced elderly breast cancer were included in this study. There were 1,498 patients in the upfront surgery group and 693 patients in the neoadjuvant therapy group. Age, tissue grade, stage, estrogen receptor (ER), and human epidermal growth factor receptor 2 (HER-2) were independent risk factors for the prognosis of breast cancer-specific survival (BCSS) and OS (P values were less than 0.05). There were no statistically significant differences in BCSS (P=0.94) and OS (P=0.72) in the upfront surgery group compared to the NAT group. In the subgroup analysis of HER-2 positive breast cancer, OS (P=0.001) was higher in the neoadjuvant group than in the upfront surgery group.

For locally advanced HER-2 positive elderly breast cancer, NAT can improve patient survival.