Omission of surgery in elderly patients with early stage breast cancer

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• 作者：Marije E. Hamaker^a ; ^b ; ^{mhamaker@diakhuis.nl} ; Esther Bastiaannet^c ; ^d ; Dorothea Evers^e ; Willemien van de Water^c ; Carolien H. Smorenburg^f ; Ed Maartense^g ; Anneke M. Zeilemaker^h ; Gerrit-Jan Liefers^c ; Lydia van der Geestⁱ ; Sophia E. de Rooij^j ; Barbara C. van Munster^j ; ^k ; Johanneke E.A. Portielje^e
• 关键词：Early breast cancer ; Elderly ; Primary endocrine treatment
• 刊名：European Journal of Cancer
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：49
• 期：3
• 页码：545-552
• 全文大小：334 K

文摘

<h4 class=""h4"">Aimh4>To assess national trends over time in surgery for elderly patients with resectable breast cancer (BC) and to evaluate clinical outcome and cause of death after the omission of surgery in a regional cohort of elderly patients.<h4 class=""h4"">Methodsh4>

National trends in 1995-2005 were calculated using cancer registry data. In addition, a chart review was performed in a cohort of patients aged ?75 years, with early stage BC but no primary surgery, diagnosed at five Dutch hospitals in 1990-2005. Patient characteristics, comorbidity and reason for the omission of surgery were collected from the chart. Cause of death was retrieved from death certificate data registered at Statistics Netherlands.<h4 class=""h4"">Resultsh4>

Omission of surgery increased significantly over time for patients aged 80 years and older (p < 0.05). Of the 187 patients in the regional cohort (median age 85.9 years (range 75.0-97.7), 174 (92 % ) received hormonal therapy. Omission of surgery was at the patient¡¯s request in 59 patients (32 % ). Of the 178 patients that died during follow-up, 60 patients (34 % ) died of BC. For 81 patients (45 % ), BC was not clinically relevant at the time of death. Median overall survival was 2.3 years (range 0.2-10.7) and did not differ between BC and other causes of death (p = 0.9).<h4 class=""h4"">Conclusionh4>

Omission of surgery for elderly patients with resectable BC has increased significantly over the past decade; instead patients often received primary endocrine treatment. Although this may appear an effective alternative to surgery, the potential for a longer term negative impact on disease control and quality of life deserves further investigation.