Abstract
BackgroundWe aimed to ascertain population-based practice patterns and survival outcomes of postoperative radiotherapy following breast conserving-surgery (BCS) in elderly women (aged ≥65 years) with early-stage pure mucinous breast carcinoma (PMBC).MethodsPatients aged ≥65 years diagnosed with T1–2N0 and hormone receptor-positive PMBC between 1990 and 2010 were identified from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan-Meier method, Multivariate Cox proportional hazards models, and propensity score matching (PSM) were used for statistical analysis.ResultsWe enrolled 3416 patients, including 1225 (35.9%) and 2191 (64.1%) in the no-radiotherapy and radiotherapy cohorts, respectively. The percentage of patients receiving postoperative radiotherapy following BCS was significantly lower after 2004 (59.5% between 2004 and 2010), relative to that before 2004 (71.1% between 1990 and 2003; P < 0.001). Before PSM, the 10-year breast cancer-specific survival (BCSS) rates were 98.1 and 93.2% for patients with and without postoperative radiotherapy (log-rank test, P < 0.001), respectively. In the PSM cohort, receiving postoperative radiotherapy was associated with better BCSS rates, with 10-year BCSS rates of 97.6 and 94.5% in patients with and without postoperative radiotherapy, respectively (log-rank test, P = 0.001). Multivariate Cox proportional analysis indicated that receiving postoperative radiotherapy was an independent factor associated with better BCSS before (P < 0.001) and after PSM (P = 0.001), relative to those not receiving postoperative radiotherapy.ConclusionsThis study shows a decreasing utilization of postoperative radiotherapy following BCS of elderly PMBC patients over time. However, postoperative radiotherapy following BCS should be administered for elderly women with PMBC owing to independent association with better survival.
Highlights
We aimed to ascertain population-based practice patterns and survival outcomes of postoperative radiotherapy following breast conserving-surgery (BCS) in elderly women with early-stage pure mucinous breast carcinoma (PMBC)
PMBC has distinct clinicopathological and molecular features, including higher estrogen receptor (ER) and progesterone receptor (PR) expression, greater likelihood of human epidermal growth factor receptor-2 (HER2)-negative status, lower grade, and lower risk of nodal metastasis [3,4,5], which all contribute to better outcomes compared to invasive ductal carcinoma (IDC); the 10-year disease-free survival rate is > 90% [6,7,8,9,10,11,12]
Independent prognostic factors associated with breast cancer-specific survival (BCSS) Over a median follow-up period of 95 months in the non-propensity score matching (PSM) cohort, we found that 1591 (46.6%) patients died, including 110 (3.2%) patients who died of breast cancer
Summary
We aimed to ascertain population-based practice patterns and survival outcomes of postoperative radiotherapy following breast conserving-surgery (BCS) in elderly women (aged ≥65 years) with early-stage pure mucinous breast carcinoma (PMBC). In patients with invasive breast carcinoma, several prospective clinical trials have indicated that the omission of postoperative radiotherapy (RT) following BCS is safe and associated with an acceptable low risk of local recurrence and without a detriment to overall survival (OS) among female patients who are elderly (aged ≥50, 65, or 70 years), tumor size ≤5 cm (T1–2), node-negative (N0) disease, and ER-positive tumors [15,16,17,18]. None of these trials specified whether PMBC patients were enrolled. We used data from the large and contemporary Surveillance, Epidemiology, and End Results (SEER) program to determine population-based practice patterns and survival outcomes in PMBC patients receiving postoperative RT, among the elderly population
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