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Locoregional recurrence and mortality after breast cancer surgery in patients aged 85 and older
David Foulad1, Jacqueline Tsai1,2, Ingrid Luo3
1Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Purpose:
Life expectancy is increasing and the number of patients age ≥ 85 with breast cancer (BC) may be on the rise. We report descriptive statistics regarding surgical management and outcomes in this cohort.
Methods:
Patients ≥ 85 years surgically treated for a primary or in-breast tumor recurrence (IBTR) were identified through Oncoshare, a database that links Stanford Healthcare and Sutter Health electronic medical records with the California Cancer Registry.
Results:
From 2010 to 2019, 91 patients, 65 (71%) aged 85-89 and 26 (29%) ≥ 90 + years were identified. 29.2% were screen-detected compared to 57.7% with a prior BC. Lumpectomy was performed in 70% of 96 cancers, nodal staging in 36% of lumpectomies and 91% of mastectomies. Locoregional recurrences (LRR) occurred in 18 patients, 17 after lumpectomy and two BC-related deaths. BC-specific survival was 100.0% at 3 years and 98.0% (95%CI: 94.3%-100.0%) at 5 years. Overall survival (OS) was 77.9% (95% CI: 68.8%-88.1%) at 3 years and 59.9% (95% CI: 49.3%-72.6%) at 5 years. Five-year OS was 71.9% (95% CI: 60.4%-85.6%) for those 85-89 years vs. 28.3% (95% CI: 13.6%-58.6%) for those ≥ 90 years, (p < 0.001). Life expectancy, estimated as median OS, was 7.6 (85-89)and 3.5 (> 90) years. The cumulative incidence of LRR was 4.6%(95% CI: 2.2-9.0%) at 3 years and 13.4%(95% CI: 5.9-20.8%) at 5 years, factoring death as a competing risk using the Aalen-Johansen estimator.
Conclusion:
Surgery achieves satisfactory local control of disease in patients ≥ 85 years with a new BC or IBTR.
