Effect of omission of surgery on survival in patients aged 80 years and older with early-stage hormone receptor-positive breast cancer.

A Z De Boer,J E A Portielje,L De Munck,S Siesling,O M Dekkers,E Bastiaannet,N A De Glas,K M De Ligt,G J Liefers,P J Marang-Van De Mheen

doi:10.1002/bjs.11568

Abstract

BackgroundSurgery is increasingly being omitted in older patients with operable breast cancer in the Netherlands. Although omission of surgery can be considered in frail older patients, it may lead to inferior outcomes in non‐frail patients. Therefore, the aim of this study was to evaluate the effect of omission of surgery on relative and overall survival in older patients with operable breast cancer.MethodsPatients aged 80 years or older diagnosed with stage I–II hormone receptor‐positive breast cancer between 2003 and 2009 were selected from the Netherlands Cancer Registry. An instrumental variable approach was applied to minimize confounding, using hospital variation in rate of primary surgery. Relative and overall survival was compared between patients treated in hospitals with different rates of surgery.ResultsOverall, 6464 patients were included. Relative survival was lower for patients treated in hospitals with lower compared with higher surgical rates (90·2 versus 92·4 per cent respectively after 5 years; 71·6 versus 88·2 per cent after 10 years). The relative excess risk for patients treated in hospitals with lower surgical rates was 2·00 (95 per cent c.i. 1·17 to 3·40). Overall survival rates were also lower among patients treated in hospitals with lower compared with higher surgical rates (48·3 versus 51·3 per cent after 5 years; 15·0 versus 19·7 per cent after 10 years respectively; adjusted hazard ratio 1·07, 95 per cent c.i. 1·00 to 1·14).ConclusionOmission of surgery is associated with worse relative and overall survival in patients aged 80 years or more with stage I–II hormone receptor‐positive breast cancer. Future research should focus on the effect on quality of life and physical functioning.

Highlights

The number of older patients with breast cancer is increasing owing to ageing of Western populations[1,2]
Patients aged 80 years or older diagnosed with stage I–II hormone receptor-positive breast cancer between 2003 and 2009 were selected from the Netherlands Cancer Registry (NCR) and included in this study
This study showed that omission of surgery had no effect during the first 5 years of follow-up, but was associated with worse relative and overall survival after 5 years in patients aged 80 years or older with stage I–II hormone receptor-positive breast cancer

Summary

Introduction

The number of older patients with breast cancer is increasing owing to ageing of Western populations[1,2]. Previous studies[7,8,9] have shown that the percentage of older patients who do not undergo primary surgical treatment has increased over the past decade in the Netherlands. Most of these patients receive primary endocrine therapy instead of surgery. The aim of this study was to evaluate the effect of omission of surgery on relative and overall survival in older patients with operable breast cancer. Conclusion: Omission of surgery is associated with worse relative and overall survival in patients aged 80 years or more with stage I–II hormone receptor-positive breast cancer. Future research should focus on the effect on quality of life and physical functioning

Objectives

Methods

Results

Conclusion