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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Article Info
Publication History
Published online: September 26, 2018
Accepted:
September 21,
2018
Received:
July 22,
2018
Footnotes
H.P. and K.Z. contributed equally to this work.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
