Elderly women with non-metastatic BC do not always receive standard of care definitive surgical treatment. Both provider and patient related reasons have been cited. The impact of omitting surgery in elderly patients who otherwise would be candidates for surgery has not been addressed. We performed a population based study to evaluate the impact of lack of surgery on survival outcomes in elderly women with BC in modern era.
The Surveillance, Epidemiology and End Results database was queried from 2010 to 2013 for female patients age 60 and older with a diagnosis of invasive ductal or lobular BC with AJCC stage I, II, III. To determine the relationship between surgery at diagnosis and survival and to take into consideration the effect of comorbidities, we organized patients in the following groups: a. Surgery performed, b. Surgery recommended, but not performed; c. Surgery not recommended and not performed. The Kaplan –Meier method was used to generate survival curves and the log-rank test was performed to compare OS rates among different groups.
119,404 patients were eligible with a median age between 70 to 74 years old. 71,638 (60%) patients were stage I, 37,524 (31.42%) were stage II and 10,245 (8.58%) were stage III. 85.2% were ER +, 12.4% were Her 2 + and 8.8% were triple negative (TN). Compared with the patients who received surgery, patients who did not receive surgery had a significantly worse outcome (all patients: HR = 7.39, 95% CI, 6.98–7.83, P
Definitive surgery should be performed in medically-fit elderly patients with non-metastatic BC due to a significant survival benefit.
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All authors have declared no conflicts of interest.