Consider Node Dissection, Adjuvant Therapy in Elderly Breast Cancer Patients

BALTIMORE—Axillary lymph node status and hormone receptor status are significant prognostic factors in elderly breast cancer patients, warranting more careful consideration of lymph node dissection and adjuvant therapy, according to a review of 277 cases presented at the San Antonio Breast Cancer Symposium.

The presence of lymph node metastases predicted significantly lower survival, which was improved in patients who had lymph node dissection. Estrogen-receptor (ER)-positive patients had increased survival during 5-year follow-up.

“Older patients often receive less aggressive breast cancer care because of considerations related to tolerance, adherence, and concomitant illness,” said Daniel Yoon, MD, of Johns Hopkins University. “These results indicate that older patients may derive substantial benefit from more aggressive care, including axillary node dissection and systemic therapies.”

Dr. Yoon and his colleagues reviewed medical records on 277 patients age 70 and older with invasive ductal carcinoma . None of the women had received any form of systemic adjuvant therapy. The mean age at diagnosis was almost 76 years; median follow-up was about 7 years; and median tumor size was 3.5 cm. Ninety patients (32.5%) had secondary malignancies. The majority of patients had radical mastectomy (62.8%).

Among the 200 patients who had axillary lymph node dissection, 31% had nodal metastases. Survival averaged 6.43 years in patients with negative nodes vs 4.06 years in patients with nodal invasion (P = .0023). Five-year survival exceeded 75% in node-negative patients but was less than 70% in those with positive nodes.

Axillary dissection had a significant impact on survival. Among patients who had mastectomy or lumpectomy plus nodal dissection, 10-year survival was almost 50% vs about 20% in patients who did not have axillary lymph node dissection (P = .0093).

A review of hormone-receptor status showed that 73.4% of the patients were ER positive and 58% were progesterone-receptor positive. The ER-positive patients had a 5-year breast cancer-specific survival of 73.4%, compared with less than 60% in ER-negative patients (P < .05).

Age was the only other significant predictor of survival, as patients younger than 80 years lived longer than older patients.

“Axillary lymph node dissection is needed in older patients with breast cancer,” Dr. Yoon concluded. “The power of hormone-receptor status to predict survival may indicate the need for closer and more complete consideration of adjuvant systemic therapies in elderly patients.”

The data showed that a majority of the 277 patients died of noncancer causes, Dr. Yoon added.