Survival benefit from axillary surgery in patients aged 70 years or older with clinically node-negative breast cancer: A population-based propensity-score matched analysis |
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| Institution: | 1. Department of Surgery, Hanyang University College of Medicine, Seoul, South Korea;2. Department of Surgery, Gangnam Severance Hospital, Yonsei Univeristy College of Medicine, Seoul, South Korea;3. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea;4. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;5. Department of Surgery, Korea Cancer Centre Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, South Korea;6. Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea;7. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea;8. Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea;1. Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People''s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China;2. Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China;3. NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, 310003, China;4. Institute of Organ Transplantation, Zhejiang University, Hangzhou, 310003, China;1. Division of Endocrine Surgery, National University Health System, 119074, Singapore;2. Division of Endocrine Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, 274 Grosvenor Rd, Belfast, BT12 6BA, UK;3. Yong Loo Lin School of Medicine, 10 Medical Dr, 117597, Singapore;1. Gynaecologic Oncology Unit, Vall d''Hebron University Hospital, Barcelona, Spain;2. Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain;3. Information Systems, Vall d’Hebron University Hospital, Barcelona, Spain;4. Biomedical Research Group in Gynaecology, Vall d''Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERONC, Barcelona, Spain;1. Department of Hematology and Oncology, Asklepios Hospital Barmbek, Hamburg, Germany;2. Asklepios Campus Hamburg, Semmelweis University, Budapest, Hungary;3. Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany;4. Surgical Clinic Unit, Department of Surgery and Medical Surgical Specialties, University of Catania, Italy;1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan |
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| Abstract: | BackgroundOlder patients with breast cancer have good prognosis and most die from diseases other than breast cancer. Previous studies suggested that the surgical extent in older patients could be reduced. We aimed to compare survival outcomes in patients aged ≥70 years with clinically node-negative breast cancer, based on whether axillary surgery was performed.MethodsA total of 2,995 patients with breast cancer aged ≥70 years who underwent breast surgery were included in the Korean Breast Cancer Registry. Patients were classified into two groups according to the performance of axillary surgery. We used propensity score matching for demographic and treatment factors to minimize selection bias. We compared the 5-year overall survival (OS) and breast cancer-specific survival (BCSS).ResultsAmong 708 patients after 3:1 propensity score matching, 531 underwent breast surgery with axillary surgery and 177 underwent breast surgery alone. Of all patients, 51.7% had T1 stage, and 73.2% underwent mastectomy. Approximately 31.2% of patients received chemotherapy. Among patients who did not undergo axillary surgery, the 5-year OS and BCSS rates were 85.2% and 96.7%, respectively. The hazard ratio of axillary surgery for OS was 0.943 (95% confidence interval 0.652–1.365, p = 0.757), indicating no significant difference between two groups.ConclusionsOur study demonstrates that axillary surgery in a matched cohort of older patients with breast cancer and clinically negative nodes does not provide a survival benefit compared to patients undergoing breast surgery alone. These findings suggest that axillary surgery may be safely omitted in a select group of patients aged ≥70 years with clinically node-negative cancer. Further studies are needed to identify potential candidates for omitting axillary surgery. |
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| Keywords: | Axillary surgery Breast cancer Older patients Survival outcome |
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