Abstract P3-10-39: Prognostic Factors in 337 Elderly Women with Metastatic Breast Cancer
Authors: Follana P , Chamorey E , Dadone B , Gal J , Courdi A , Barriere J , Largillier R , Mari V , Raoust I , Ettore F , Maestro C , Ferrero J-M. 
Published: April 2011

Background: We have studied a cohort of elderly women with metastatic breast cancer (MBC) who were treated in our institution and determined a list of factors easily available in routine clinical practice that could predict specific survival of patients after diagnosis of metastasis. Patients and methods: From 1975 to 2005, a total of 337 female breast cancer patients were included into this analysis. They all developed metastases after the age of 70 during their follow-up. Patients were subsequently classified in 3 groups according to the period of metastatic diagnosis (&lt;1992, &lt;2000 and &gt;2000).

Results: Median specific survival and 95% confident interval (CI) was 21.0 months [16.5-23.0]. Survival rates were 61.7 % [56.7-67.1], 43.0 %[38.1-48.7], 31.5 %[26.9-36.8] and 18.7 %[15.0-23.4] at 1, 2, 3 and 5 years respectively. In univariate analysis, for variables measured at initial diagnosis of breast cancer, it was shown that age (p&lt;10-3), hormonal receptor status (p&lt;10-3), number of positive lymph nodes (p&lt;10-3) and SBR staging (p=0.02) were relevant prognostic factors to predict specific survival from the time of metastatic occurrence. Metastasis-free interval (time between initial diagnosis and metastasis) (p&lt;10-6) and sites of metastases (p&lt;10-6) were also significant factors predicting specific survival. Patients with secondary lymph nodes, skin, bone and lung metastatic locations had a significantly better survival than patients having liver, brain or multiple metastatic locations. Interestingly, the period of metastatic diagnosis (p=0.67) and age of patient at metastasis (p=0.35) were not significantly related to the survival rate. In multivariate analysis, old age at initial diagnosis of breast cancer (HR and 95% CI: 1.03 [1.01-1.06]), positive hormonal receptor status (HR and 95% CI: 0.61 [0.39-0.96]) and site of metastasis remains independent factors predicting specific survival.

Discussion: Only few studies reported prognostic factors in elderly patients with MBC. In our study, we show that this population is likely to be divided into 2 groups. The first one will include aged patients at initial breast cancer diagnosis with aggressive tumors showing negative hormonal receptor status and liver, brain or multiple metastatic sites. The second one will show opposite features. Moreover this study provides no evidence of improvement in prognosis of elderly MBC patients within the last 20 years. This could be attributed to the physician's reluctance to introduce new systemic treatment agents in this population at risk of increased toxicity. These survival prognostic factors mentioned above associated with the use of a questionnaire to screen for frailty in the elderly may assist physicians in evaluating the patient's survival potential and choose a tailored treatment to this cancer population.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-39.