Abstract P3-13-02: Impact of primary surgery on short-term survival of older breast cancer patients in the UK
Authors: Bundred N , Lavelle K , Sowerbutts AM , Pilling M , Todd C 
Published: March 2017

Introduction

Lack of surgery for older breast cancer patients may reduce cancer survival. Previous studies did not adjust for comorbidity and tumour characteristics which affect survival.

Methods

In a prospective cohort study investigating older patients' treatment, survival analyses (mean 3.8 years, 95% CI: 3.69-3.83) was undertaken for 910 breast cancer patients aged ≥65 years diagnosed at 22 English hospitals from 1/7/10 to 31/12/12. Primary outcome was breast cancer specific survival. Independent variables included surgery, comorbidity, functional status and tumour characteristics recorded from patient interview (at diagnosis) and case note review. Data analyses included Cox's multiple regression.

Results

Adjusting for tumour stage, comorbidity and functional status, women undergoing primary surgery (n=772) had a third of the hazard of breast cancer death compared to those who did not (n=138) (HR 0.36, 95% CI: 0.20-0.66, p=0.001). The number of observed breast cancer deaths exceeded those expected for participants who did not have primary surgery, were aged ≥85 years, steroid receptor negative or had a higher grade or stage tumour. In univariate analysis women aged ≥85 years had an increased hazard of breast cancer death compared to 65-69 year olds (HR 4.02, 95% CI: 1.61-10.01, p=0.003). Patients' role in the treatment decisions did not alter whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive (i.e. left the decision up to the Surgeon).

Conclusions

Surgery for older breast cancer patients reduces the hazard of cancer death by a third, independent of age, comorbidity and tumour characteristics. Surgeons must actively advise surgery for all elderly patients.

Cox's proportional hazards regression of breast cancer specific survival (unadjusted n=906)VariableCategoryUnadjusted HRUnivariable 95% CIP ValueAdjusted HR#Multivariable 95% CIP ValuePrimary surgeryNo(ref)  (ref)   Yes0.320.19-0.53&lt;0.0010.360.20-0.660.001Age group (years)65-69(ref)  (ref)   70-741.530.61-3.860.3641.310.52-3.340.565 75-791.350.51-3.540.5481.040.39-2.770.933 80-842.390.92-6.220.0741.720.65-4.560.272 85+4.021.61-10.010.0032.610.99-6.910.053Grade1(ref)  (ref)   21.370.60-3.140.4531.180.51-2.710.704 34.552.01-10.31&lt;0.0013.231.36-7.650.008ER or PR positiveYes(ref)  (ref)   No3.502.02-6.08&lt;0.0012.751.49-5.090.001Tumour StageI(ref)  (ref)   II and IIIa2.251.33-3.810.0021.480.85-2.570.164Co-morbidity (Charlson)0(ref)  (ref)   11.020.60-1.740.9350.970.56-1.670.917 2+0.960.50-1.840.9020.800.41-1.570.518Functional status*Independent (1-2)(ref)  (ref)   Dependent (3-4)1.690.97-2.950.0641.000.53-1.880.995# Adjusted for all other variables in table

(Funded by NIHR Programme Grant).

Citation Format: Bundred N, Lavelle K, Sowerbutts AM, Pilling M, Todd C. Impact of primary surgery on short-term survival of older breast cancer patients in the UK [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-02.