Effect of omission of surgery on survival in patients aged 80 years and older with early-stage hormone receptor-positive breast cancer.

Autor: de Boer AZ; Department of Surgery, Leiden, the Netherlands.; Department of Medical Oncology, Leiden, the Netherlands., de Glas NA; Department of Medical Oncology, Leiden, the Netherlands., Marang-van de Mheen PJ; Department of Medical Decision-Making, Leiden, the Netherlands., Dekkers OM; Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands., Siesling S; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands., de Munck L; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands., de Ligt KM; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands., Liefers GJ; Department of Surgery, Leiden, the Netherlands., Portielje JEA; Department of Medical Oncology, Leiden, the Netherlands., Bastiaannet E; Department of Surgery, Leiden, the Netherlands.; Department of Medical Oncology, Leiden, the Netherlands.
Jazyk: angličtina
Zdroj: The British journal of surgery [Br J Surg] 2020 Aug; Vol. 107 (9), pp. 1145-1153. Date of Electronic Publication: 2020 Apr 07.
DOI: 10.1002/bjs.11568
Abstrakt: Background: Surgery is increasingly being omitted in older patients with operable breast cancer in the Netherlands. Although omission of surgery can be considered in frail older patients, it may lead to inferior outcomes in non-frail patients. Therefore, the aim of this study was to evaluate the effect of omission of surgery on relative and overall survival in older patients with operable breast cancer.
Methods: Patients aged 80 years or older diagnosed with stage I-II hormone receptor-positive breast cancer between 2003 and 2009 were selected from the Netherlands Cancer Registry. An instrumental variable approach was applied to minimize confounding, using hospital variation in rate of primary surgery. Relative and overall survival was compared between patients treated in hospitals with different rates of surgery.
Results: Overall, 6464 patients were included. Relative survival was lower for patients treated in hospitals with lower compared with higher surgical rates (90·2 versus 92·4 per cent respectively after 5 years; 71·6 versus 88·2 per cent after 10 years). The relative excess risk for patients treated in hospitals with lower surgical rates was 2·00 (95 per cent c.i. 1·17 to 3·40). Overall survival rates were also lower among patients treated in hospitals with lower compared with higher surgical rates (48·3 versus 51·3 per cent after 5 years; 15·0 versus 19·7 per cent after 10 years respectively; adjusted hazard ratio 1·07, 95 per cent c.i. 1·00 to 1·14).
Conclusion: Omission of surgery is associated with worse relative and overall survival in patients aged 80 years or more with stage I-II hormone receptor-positive breast cancer. Future research should focus on the effect on quality of life and physical functioning.
(© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)
Databáze: MEDLINE
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