Matched case-control survival analysis of older chinese breast cancer patients treated with surgery or primary endocrine therapy.
Breast cancer
case-control matching
older chinese patients
primary endocrine therapy
surgery
Journal
Cancer treatment and research communications
ISSN: 2468-2942
Titre abrégé: Cancer Treat Res Commun
Pays: England
ID NLM: 101694651
Informations de publication
Date de publication:
2020
2020
Historique:
received:
24
07
2020
revised:
05
10
2020
accepted:
16
10
2020
pubmed:
30
10
2020
medline:
18
11
2021
entrez:
29
10
2020
Statut:
ppublish
Résumé
Primary endocrine therapy (PET) has been used as an alternative to primary surgery for elderly with estrogen receptor (ER) positive breast tumors. Such practices are less commonly performed in Asian countries and the response to PET in Chinese cohort is still lacking. This study aims to compare the clinical outcome of PET to primary surgery. Medical records of Chinese patients aged 70 and above with stage I to III, ER positive breast cancer treated at a University affiliated tertiary hospital from 2008 to 2017 were reviewed. Excluding those with extreme comorbidity, a one-to-one case-control survival analysis of patients treated with PET or primary operation was performed, using propensity score case-match analysis to adjust for confounding factors. 292 patients fulfilled the inclusion criteria during the study period. 209 patients received primary operation, whereas 83 patients received PET. Excluding those with extreme comorbidity, a one-to-one matching was performed, and the dataset was stratified into survival time within 0-5 years and beyond 5 years. Both groups had similar survival within 0-5 years (p = 0.63). The survival curves diverged beyond 5 years, with a significantly better outcome in patients operated than those treated with PET (p = 0.0029). For frail older patients with limited life expectancy, PET may be appropriate since equivalent survival can be achieved for PET with or without surgery. Those patients with longer life expectancy may gain survival benefits from local treatment. A comprehensive geriatric assessment is useful to predict the survival probability and guide the optimal treatment.
Sections du résumé
BACKGROUND
Primary endocrine therapy (PET) has been used as an alternative to primary surgery for elderly with estrogen receptor (ER) positive breast tumors. Such practices are less commonly performed in Asian countries and the response to PET in Chinese cohort is still lacking. This study aims to compare the clinical outcome of PET to primary surgery.
PATIENTS AND METHODS
Medical records of Chinese patients aged 70 and above with stage I to III, ER positive breast cancer treated at a University affiliated tertiary hospital from 2008 to 2017 were reviewed. Excluding those with extreme comorbidity, a one-to-one case-control survival analysis of patients treated with PET or primary operation was performed, using propensity score case-match analysis to adjust for confounding factors.
RESULTS
292 patients fulfilled the inclusion criteria during the study period. 209 patients received primary operation, whereas 83 patients received PET. Excluding those with extreme comorbidity, a one-to-one matching was performed, and the dataset was stratified into survival time within 0-5 years and beyond 5 years. Both groups had similar survival within 0-5 years (p = 0.63). The survival curves diverged beyond 5 years, with a significantly better outcome in patients operated than those treated with PET (p = 0.0029).
CONCLUSIONS
For frail older patients with limited life expectancy, PET may be appropriate since equivalent survival can be achieved for PET with or without surgery. Those patients with longer life expectancy may gain survival benefits from local treatment. A comprehensive geriatric assessment is useful to predict the survival probability and guide the optimal treatment.
Identifiants
pubmed: 33120314
pii: S2468-2942(20)30062-9
doi: 10.1016/j.ctarc.2020.100227
pii:
doi:
Substances chimiques
Antineoplastic Agents, Hormonal
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100227Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.