Treatment strategies and predicting prognoses in elderly patients with breast cancer

Zhi Wang,^1,2,* Zhangjian Zhou,^1,* Wenxing Li,¹ Wei Wang,³ Xin Xie,¹ Jincheng Liu,² Yongchun Song,¹ Chengxue Dang,¹ Hao Zhang<sup>1

1</sup>Division of Surgical Oncology, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; ²Division of Surgery, Shaanxi Tuberculosis Hospital, Changan District, Xi’an, Shaanxi, People’s Republic of China; ³Division of Gynaecology and Obstetrics, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China

*These authors contributed equally to this work

Objective: The prevalence of breast cancer in elderly women (older than 80 years) is expected to rise more dramatically than its incidence. In this study, we evaluated the evidence for treatment guidelines for elderly breast cancer patients.
Patients and methods: All included patients were enrolled from 2010 to 2013 from the Surveillance, Epidemiology, and End Results (SEER) database. The Akaike information criterion (AIC) and Harrell’s C statistic were used to perform comparisons. In addition, a propensity score analysis was used to avoid bias caused by data selection criteria. Prognostic factors were selected as nomogram parameters to develop a model to predict survival.
Results: A total of 16998 patients included in the SEER database from 2010 to 2013 had breast cancer and fulfilled the study criteria. Of whom, 13007 patients underwent surgery. Overall survival and cancer-specific survival were significantly better in patients who underwent surgery and/or radiotherapy than in those who did not (P<0.001). In addition, a nomogram system with a C index of 0.83 and an AIC index of 11112.85 was better able to predict prognoses and estimate cancer-specific survival in elderly patients with breast cancer.
Conclusion: A localized surgical approach might provide better results in elderly breast cancer patients. However, radiotherapy improved cancer-specific survival and overall survival in these patients. In addition, a prognostic nomogram directly quantified patient risk by accounting for various prognostic factors without forming risk groups and was better able to estimate cancer-specific survival.

Keywords: breast cancer, elderly patients, survival, prediction, nomogram