The Clinicopathological Characteristics Of Older Patients With Breast Cancer And The Analysis Of Treatment Patterns And Prognosis

Objective:To summarize clinicopathological characteristics, comorbidities and treatment patterns of elder breast cancer patients. Compare the characteristics of the different age groups, matched with research abroad and discuss the characteristics of older patients in china. Analyze the factors influencing treatment patterns and prognosis. Provide theoretical basis for personal treatments scheme fit for Chinese elder breast cancer patients.Methods:This retrospective cohort included977patients(≥65) of primary breast cancer women diagnosed and treated in Tianjin Medical University Cancer Institute and Hospital between January1,2005and December31,2009according to inclusion and exclusion criteria. We followed up all patients until the date January31,2013.The clinicopathological, biological characteristics and comorbidities were concluded and analyzed. The patients were divided into four groups:65-69,70-74,75-79and≥80years old according to age. The indicator of assessing prognosis was overal survival (OS) and diseases-free survival (DFS). Statistical analyses were carried out with SPSS version17.0. The chi-square test and Fisher exact test were used to compare the difference between four age groups. The survival curves were estimated by the Kaplan-Meier method and compared by Log-Rank test, and COX model for multivariate factors analysis, with p<0.05defined as a statistically significant difference.Results:The median age was71years old (ranging from65to102years old). The number of elderly patients increased year after year and age between65and74years old accounted for the most. Most patients presented with breast tumor. Invasive ductal carcinoma was the main pathological type and grade2was the main histological grade. Most of the patients were pathological stage Ⅰ and Ⅱ.The positivity of ER and PR were68.7%and61.5%, respectively, and68.6%patients were Luminal A. The four age groups had difference in pathological type, tumor size and P53status. The pathological type with good prognosis and T3-4stage increased with age. The pathological type with poor prognosis and T1-2stage decreased with age. The older patients were more likely to have bigger tumor. The presentation of2+and3+of P53decreased with age.Hypertension was the most common comorbidities in all age groups. Heart disease, diabetes mellitus and over two comorbidities increased with age. Age was an important factor influencing treatments. With aging, patients were less likely to receive radical mastectomy and modified radical mastectomy and more likely to receive breast conserving surgery and mastectomy. Patients received less chemistry, radiotherapy and endocrine therapy. Other factors, such as pathological type, tumor size, lymph node status, histological grade, PR status, Ki67, P53and high risk of reccurence, also influenced treatment.893patients had complete following-up data. After median follow-up of57months, the5-year overall survival rate was84.8%.140cases died and44cases (31.4%) died from non-breast cancer. The proportion of dying from non-breast cancer increased with age. Surgical patterns, vascular invasion, tumor size and PR status were the independent prognostic factors for OS. Pathological type, lymph node status and adjuvant endocrine therapy were the independent prognostic factors for DFS.Conclusions:The elderly breast cancer patients had pathological and biological type of good prognosis. Hypertension was the most common comorbidities in all age groups. Age was an important factor influencing treatments. With aging, patients were more likely to receive breast conserving surgery and mastectomy and received less chemistry, radiotherapy and endocrine therapy. Surgical patterns, vascular invasion, tumor size, lymph node status, PR status and adjuvant endocrine therapy were all important prognostic factors.