Locoregional recurrence and mortality after breast cancer surgery in patients aged 85 and older.

PURPOSE: Life expectancy is increasing and the number of patients age ≥ 85 with breast cancer (BC) may be on the rise. We report descriptive statistics regarding surgical management and outcomes in this cohort.

METHODS

Patients ≥ 85 years surgically treated for a primary or in-breast tumor recurrence (IBTR) were identified through Oncoshare, a database that links Stanford Healthcare and Sutter Health electronic medical records with the California Cancer Registry.

RESULTS

From 2010 to 2019, 91 patients, 65 (71%) aged 85-89 and 26 (29%) ≥ 90 + years were identified. 29.2% were screen-detected compared to 57.7% with a prior BC. Lumpectomy was performed in 70% of 96 cancers, nodal staging in 36% of lumpectomies and 91% of mastectomies. Locoregional recurrences (LRR) occurred in 18 patients, 17 after lumpectomy and two BC-related deaths. BC-specific survival was 100.0% at 3 years and 98.0% (95%CI: 94.3%-100.0%) at 5 years. Overall survival (OS) was 77.9% (95% CI: 68.8%-88.1%) at 3 years and 59.9% (95% CI: 49.3%-72.6%) at 5 years. Five-year OS was 71.9% (95% CI: 60.4%-85.6%) for those 85-89 years vs. 28.3% (95% CI: 13.6%-58.6%) for those ≥ 90 years, (p < 0.001). Life expectancy, estimated as median OS, was 7.6 (85-89)and 3.5 (> 90) years. The cumulative incidence of LRR was 4.6%(95% CI: 2.2-9.0%) at 3 years and 13.4%(95% CI: 5.9-20.8%) at 5 years, factoring death as a competing risk using the Aalen-Johansen estimator.

CONCLUSION

Surgery achieves satisfactory local control of disease in patients ≥ 85 years with a new BC or IBTR.