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Adjuvant endocrine therapy is associated with improved overall survival in elderly hormone receptor-positive breast cancer patients

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Abstract

Purpose

There is controversy regarding the survival benefit of endocrine therapy (ET) in elderly patients with early invasive hormone receptor-positive (HR+) breast cancer. In this study, we characterize a single institution’s practice patterns using adjuvant ET for these patients and evaluated the effect of ET on outcomes.

Methods

A review of a prospectively maintained database identified 483 women ≥ 70 years old who underwent breast -conserving surgery (BCS) for stage I-III HR+ tumors from 2004–2013. We compared clinicopathologic characteristics, overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and breast cancer-specific survival (BCSS) in patients who did and did not receive ET.

Results

Compared to patients who did not get ET, patients who received ET were younger (median age 76 vs 78 years, p = 0.006), had larger tumors (median size 15 vs 14 mm, p = 0.016), underwent sentinel lymph node (LN) biopsy (83.7 vs 67.8%, p < 0.001), had positive LNs (25.5 vs 9.8%, p = 0.008), and received radiation (XRT, 76 vs 43%, p < 0.001). After adjusting for ASA score, age, LN status, tumor grade, and XRT, receipt of ET was associated with improved OS (HR 0.44; 95% CI 0.25–0.77; p = 0.004) and DFS (HR 0.42; 95% CI 0.28–0.64; p < 0.01). Receipt of ET was associated with improved LRR on univariate analysis (HR 0.25; 95% CI 0.09–0.70; p = 0.008); however, after adjusting for grade and XRT, this was not statistically significant on multivariable analysis (HR 0.38; 95% CI 0.13–1.08; p = 0.069) and was not associated with BCSS (HR 0.59; 95% CI 0.16–2.16; p = 0.43).

Conclusions

ET was associated with significant improvements in OS and DFS, regardless of clinicopathological features; however, receipt of ET did not impact LRR and BCSS.

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Data availability

The manuscript has associated data in a data repository, which are available upon request.

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Authors and Affiliations

  1. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Jessica S. Crystal, Jamie Rand, Jeffrey Johnson, Farin Amersi, Armando E. Giuliano & Alice Chung

  2. Department of Surgical Oncology, City of Hope Cancer Center, Duarte, CA, USA

    Jamie Rand

  3. Department of Surgical Oncology, University of North Carolina, Chapel Hill, NC, USA

    Jeffrey Johnson

  4. Biostatistics and Bioinformatics Research Center, Los Angeles, CA, USA

    Sungjin Kim

  5. Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 8700 Beverly Blvd, #AC-1046A, Los Angeles, CA, 90048, USA

    Jessica S. Crystal, Reva Basho, Farin Amersi, Armando E. Giuliano & Alice Chung

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  1. Jessica S. Crystal
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Crystal, J.S., Rand, J., Johnson, J. et al. Adjuvant endocrine therapy is associated with improved overall survival in elderly hormone receptor-positive breast cancer patients. Breast Cancer Res Treat 184, 63–74 (2020). https://doi.org/10.1007/s10549-020-05823-y

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