Abstract
PurposeStudies have suggested a potential role of patient’s co-morbidity in determining the survival outcomes of breast cancer. In this study, we examined the long-term oncologic outcomes in breast cancer patients who underwent curative surgery according to their pre-existing comorbid conditions and analyzed the association between the co-morbidity and the use of adjuvant therapies.MethodsThe medical records of 2,501 patients who underwent surgery for primary breast cancer from June 2006 to June 2010 were reviewed retrospectively. The patients were classified into three groups according to preoperative ASA status determined by the anesthesiologists. Clinico-pathologic characteristics and survival outcomes of the patients were compared among the different co-morbidity groups.ResultsThere were 1,792 (71.6%), 665 (26.6%), and 44 (1.8%) patients in ASA I, II, and III, respectively. Total 95 (3.8%) deaths and 269 (10.8%) recurrences (loco-regional and distant) occurred during the median follow-up period of 71 months. Patients with high comorbidity showed significantly higher rate of deaths (51 (2.8%), 38 (5.7%) and 6 (13.6%) deaths in ASA I, II and III group, respectively, p<0.001). The ASA 3 patients also showed significantly higher rate of breast cancer recurrence when compared to other groups (180 (10.0%), 80 (12.0%) and 9 (20.5%) in ASA I, II, and III, respectively, p = 0.041). Significantly fewer patients in the high co-morbidity group received adjuvant therapies (77 (4.3%), 44 (6.6%) and 8 (18.2%) in ASA I, II, and III, respectively, p<0.001). The increased recurrence of breast cancer in the high morbidity group was mostly seen in patients who did not receive adjuvant therapies. The incidence of serious adverse effect during the adjuvant therapy did not differ according to the co-morbidity conditions.ConclusionsIn this study, high comorbidity was related to increased risk of death and recurrence in breast cancer. The increased risk of recurrence in high co-morbidity group was mostly seen in patients who did not receive adjuvant therapies. Considering the relatively low rates of serious adverse effects in high co-morbidity patients who received adjuvant therapies, active use of adjuvant therapies in selected patients may improve survival outcomes in breast cancer patients with severe co-morbidities.
Highlights
Breast cancer is the most common female malignancy and is the second common cause of cancer death in women.[1]
High comorbidity was related to increased risk of death and recurrence in breast cancer
Researchers have suggested the lower rates of adjuvant therapy as well as the natural course of the pre-existing medical conditions was the potential link between the increased risk of death and the presence of co-morbidities.[8]
Summary
Breast cancer is the most common female malignancy and is the second common cause of cancer death in women.[1]. The presence of co-morbidities pose can influence the decision on the use of the various treatment modalities. Several studies have reported a significant increase in cancer mortality and post-treatment morbidity in cancer patients with pre-existing health conditions.[2, 3]. Recent studies have suggested that the breast cancer patients who has significant co-morbidities tend to have increased treatment-related complication and deaths, and carry higher risk for overall and cancer mortalities.[4,5,6,7] Researchers have suggested the lower rates of adjuvant therapy as well as the natural course of the pre-existing medical conditions was the potential link between the increased risk of death and the presence of co-morbidities.[8] some reported that elderly patients with co-morbidities have worse survival outcome despite the similar rates of adjuvant therapy administration.[9]
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