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Palliative Local Surgery for Locally Advanced Breast Cancer Depending on Hormone Receptor Status in Elderly Patients

  • Hong Pan
    Affiliations
    Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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  • Kai Zhang
    Affiliations
    Pancreatic Center and Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China

    Pancreas Institute of Nanjing Medical University, Nanjing, Jiangsu, China
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  • Ming Wang
    Affiliations
    Department of Plastic and Burn Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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  • Lijun Ling
    Affiliations
    Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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  • Wenbin Zhou
    Correspondence
    Wenbin Zhou, Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029 Nanjing, China. Fax: 0086-25-83718836
    Affiliations
    Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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  • Shui Wang
    Correspondence
    Addresses for correspondence: Shui Wang, MD, PhD, Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029 Nanjing, China. Fax: 0086-25-83718836
    Affiliations
    Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
    Search for articles by this author
Published:September 26, 2018DOI:https://doi.org/10.1016/j.clbc.2018.09.007

      Abstract

      Background

      Many elderly breast cancer patients might just receive palliative local surgery, especially those with locally advanced breast cancer (LABC). However, palliative tumor removal might lead to perioperative residual tumor growth. In this study, we aimed to determine the survival effect of palliative local surgery without definitive axillary surgery for LABC in elderly patients.

      Patients and Methods

      Patients age 70 years or older diagnosed with T3/4M0 breast cancer, who received no surgery, mastectomy, or lumpectomy without axillary surgery, were identified in the Surveillance, Epidemiology, and End Results cancer database from 1973 to 2014. The overall survival effect of palliative local surgery was determined by using multivariable Cox regression, and propensity score matching was applied to confirm the results.

      Results

      A total of 2616 female breast cancer patients age 70 years or older diagnosed with T3/4M0 (without inflammatory breast cancer) were identified; 1374 received no cancer-directed surgery, 583 received lumpectomy without axillary surgery, and 659 received mastectomy without axillary surgery. Adjusted for potential confounders, both types of palliative local surgeries (lumpectomy: hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.71-1.27; P = .719; mastectomy: HR, 0.88; 95% CI, 0.65-1.17; P = .371) were not associated with overall survival compared with no surgery within hormone receptor-positive patients. However, mastectomy strongly improved survival within hormone receptor-negative patients. Palliative local surgery did not change the patterns of mortality.

      Conclusion

      For elderly patients diagnosed with LABC, not candidates for standard therapies, mastectomy should be recommended as palliative therapy for hormone receptor-negative, but not for hormone receptor-positive patients.

      Keywords

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