Abstract：
BACKGROUND: The population aged ≥90 years is increasing worldwide, yet nearly 50% of elderly breast cancer (BC) patients receive suboptimal treatments, resulting in high rates of BC-related mortality. We analyzed clinical and survival outcomes of nonagenarian BC patients to identify effective treatment strategies.
METHODS: This single-institution retrospective cohort study analyzed patients aged ≥90 years diagnosed with stage I-III BC between 2007 and 2018. Patients were categorized into three treatment groups: traditional surgery (TS), performed according to local guidelines; current-standard surgery (CS), defined as breast surgery without axillary surgery (in concordance with 2016 Choosing Wisely guidelines) and/or cavity shaving; and non-surgical treatment (NS). Clinicopathological features were recorded and recurrence rates and survival outcomes were analyzed.
RESULTS: We collected data from 113 nonagenarians with a median age of 93 years (range 90-99). Among these patients, 43/113 (38.1%) underwent TS, 34/113 (30.1%) underwent CS, and 36/113 (31.9%) underwent NS. The overall recurrence rate among surgical patients was 10.4%, while the disease progression rate in the NS group was 22.2%. Overall survival was significantly longer in surgical patients compared with NS patients (p = 0.04). BC-related mortality was significantly higher in the NS group than in the TS and CS groups (25.0% vs. 0% vs. 7.1%, respectively; p = 0.01). There were no significant differences in overall survival and disease-free survival between the TS and CS groups (p = 0.6 and p = 0.8, respectively), although the TS group experienced a significantly higher overall postoperative complication rate (p < 0.001).
CONCLUSIONS: Individualized treatment planning is essential for nonagenarian BC patients. Surgery, whenever feasible, remains the treatment of choice, with CS emerging as the best option for the majority of patients.
METHODS: This single-institution retrospective cohort study analyzed patients aged ≥90 years diagnosed with stage I-III BC between 2007 and 2018. Patients were categorized into three treatment groups: traditional surgery (TS), performed according to local guidelines; current-standard surgery (CS), defined as breast surgery without axillary surgery (in concordance with 2016 Choosing Wisely guidelines) and/or cavity shaving; and non-surgical treatment (NS). Clinicopathological features were recorded and recurrence rates and survival outcomes were analyzed.
RESULTS: We collected data from 113 nonagenarians with a median age of 93 years (range 90-99). Among these patients, 43/113 (38.1%) underwent TS, 34/113 (30.1%) underwent CS, and 36/113 (31.9%) underwent NS. The overall recurrence rate among surgical patients was 10.4%, while the disease progression rate in the NS group was 22.2%. Overall survival was significantly longer in surgical patients compared with NS patients (p = 0.04). BC-related mortality was significantly higher in the NS group than in the TS and CS groups (25.0% vs. 0% vs. 7.1%, respectively; p = 0.01). There were no significant differences in overall survival and disease-free survival between the TS and CS groups (p = 0.6 and p = 0.8, respectively), although the TS group experienced a significantly higher overall postoperative complication rate (p < 0.001).
CONCLUSIONS: Individualized treatment planning is essential for nonagenarian BC patients. Surgery, whenever feasible, remains the treatment of choice, with CS emerging as the best option for the majority of patients.
摘要：
背景：在全球范围内，≥90岁的人口正在增加，然而，近50%的老年乳腺癌(BC)患者接受了次优治疗，导致较高的BC相关死亡率。我们分析了非先天性BC患者的临床和生存结果，以确定有效的治疗策略。
方法：这项单机构回顾性队列研究分析了2007年至2018年间诊断为I-III期BC的年龄≥90岁的患者。患者分为三个治疗组：传统手术（TS），根据当地指南进行；现行标准手术（CS），定义为不进行腋窝手术的乳房手术（与2016年选择明智指南一致）和/或腔剃；和非手术治疗（NS）。记录临床病理特征，分析复发率和生存结果。
结果：我们收集了113名平均年龄为93岁（90-99岁）的非成年患者的数据。在这些患者中,43/113（38.1%）接受TS，34/113（30.1%）接受CS，36/113（31.9％）接受NS。手术患者的总复发率为10.4%,而NS组的疾病进展率为22.2%。与NS患者相比，手术患者的总生存期明显更长（p=0.04）。NS组的BC相关死亡率明显高于TS和CS组（25.0%vs.0%vs.7.1%,分别为；p=0.01）。TS组和CS组之间的总生存期和无病生存期没有显着差异（分别为p=0.6和p=0.8），尽管TS组术后总并发症发生率明显较高（p<0.001）。
结论：个体化的治疗计划对于非未成熟的BC患者至关重要。手术,只要可行，仍然是选择的治疗方法，CS成为大多数患者的最佳选择。
方法：这项单机构回顾性队列研究分析了2007年至2018年间诊断为I-III期BC的年龄≥90岁的患者。患者分为三个治疗组：传统手术（TS），根据当地指南进行；现行标准手术（CS），定义为不进行腋窝手术的乳房手术（与2016年选择明智指南一致）和/或腔剃；和非手术治疗（NS）。记录临床病理特征，分析复发率和生存结果。
结果：我们收集了113名平均年龄为93岁（90-99岁）的非成年患者的数据。在这些患者中,43/113（38.1%）接受TS，34/113（30.1%）接受CS，36/113（31.9％）接受NS。手术患者的总复发率为10.4%,而NS组的疾病进展率为22.2%。与NS患者相比，手术患者的总生存期明显更长（p=0.04）。NS组的BC相关死亡率明显高于TS和CS组（25.0%vs.0%vs.7.1%,分别为；p=0.01）。TS组和CS组之间的总生存期和无病生存期没有显着差异（分别为p=0.6和p=0.8），尽管TS组术后总并发症发生率明显较高（p<0.001）。
结论：个体化的治疗计划对于非未成熟的BC患者至关重要。手术,只要可行，仍然是选择的治疗方法，CS成为大多数患者的最佳选择。
