Population-based study of breast cancer in older women: prognostic factors of relative survival and predictors of treatment

BMC Cancer

Pegdwende Olivia Dialla¹  Tienhan Sandrine Dabakuyo¹  Sophie Marilier²  Julie Gentil¹  Patrick Roignot³  Ariane Darut-Jouve⁴  Marie-Laure Poillot¹  Valérie Quipourt²  Patrick Arveux¹ 

[1] EA 4184, Faculty of Medicine, University of Burgundy, 7 boulevard Jeanne d’Arc, Dijon, 21000, France

[2] Unité Pilote de Coordination en Oncogériatrie en Côte-d’Or, Hôpital de jour Gériatrique, Hôpital de Champmaillot, 2 rue Jules Violle, Dijon Cedex, 21079, France

[3] Centre de Pathologie, 33 rue Nicolas Bornier, Dijon, 21000, France

[4] Clinique Clément-Drevon, 9 rue Princes de Condé, Dijon, 21000, France

关键词: Relative survival;    Prognostic factors;    Predictors of treatment;    Elderly women;    Breast cancer;   

Others  :  1080138
DOI  :  10.1186/1471-2407-12-472

 received in 2012-08-01, accepted in 2012-10-09,  发布年份 2012

【 摘 要 】

Background

A large proportion of women with breast cancer (BC) are elderly. However, there is a lack of information regarding BC prognostic factors and care in this population. The aims of this study were to assess the prognostic factors of relative survival (RS) among women with BC aged ≥ 75 years old and to identify the predictive factors of treatments administered to this population.

Methods

A population-based study was performed using data from the Cote d’Or breast and gynaecological cancer registry. Women aged 75 years and older with primary invasive BC and resident in Cote d’Or at the time of diagnosis made between January 1998 and December 2008 were retrospectively selected. Prognostic factors of RS were estimated in a generalized linear model with a Poisson error structure. RS rate for the whole population was given at 5 years. Logistic regression models were used to identify the predictors of the treatments administered.

Results

Six hundred and eighty-one women were included. Median age at diagnosis was 80. Comorbidities (p=0.02), pT stage (p=0.04), metastases (p=<0.001), having a family doctor (p=0.03) and hormone-receptor status (p=0.006) were independent prognostic factors of RS. The RS rate at 5 years for the whole population was 78.2%, 95%CI = [72.2-83.0]. Age, pT stage, metastases, histoprognostic SBR grade, hormone receptor status and comorbidities were frequently found to be predictors of treatment with surgery alone, hormone therapy alone, breast conserving surgery plus adjuvant therapy and mastectomy plus adjuvant therapy.

Conclusions

Comorbid conditions adversely affect survival in older women with breast cancer. Moreover the results of this study showed that there are numerous predictors of the type of treatment administered, and that the most important were age and comorbidities.

【 授权许可】

   
2012 Dialla et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Boyle P, Ferlay J: Cancer incidence and mortality in Europe 2004. Ann Oncol 2005, 16:481-488.
• [2]Colonna M, Danzon A, De Lafosse P, Mitton N, Bara S, Bouvier A-M, Ganry O, Guizard A-V, Launoy G, Molinie F, Sauleau E-A, Schvartz C, Velten M, Grosclaude P, Tretarre B: Cancer prevalence in France: time trend, situation in 2002 and extrapolation to 2012. Eur J Cancer 2008, 44:115-122.
• [3]Belot A, Grosclaude P, Bossard N, Jougla E, Benhamou E, Delafosse P, Guizard AV, Molinié F, Danzon A, Bara S, Bouvier AM, Trétarre B, Binder-Foucard F, Colonna M, Daubisse L, Hédelin G, Launoy G, Le Stang N, Maynadié M, Monnereau A, Troussard X, Faivre J, Collignon A, Janoray I, Arveux P, Buemi A, Raverdy N, Schvartz C, Bovet M, Chérié-Challine L, Estève J, Remontet L, Velten M: Cancer incidence and mortality in France over the period 1980-2005. Rev Epidemiol Sante Publique 2008, 56:159-175.
• [4]La situation du cancer en France en 2011: Collection rapports et synthèses, ouvrage collectif Edité par l’INCa. Boulogne-Billancourt; 2011.
• [5]Kim KJ, Huh SJ, Yang JH, Park W, Nam SJ, Kim JH, Lee JH, Kang SS, Lee JE, Kang MK, Park YJ, Nam HR: Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol 2005, 35:126-133.
• [6]Dabakuyo TS, Bonnetain F, Roignot P, Poillot M-L, Chaplain G, Altwegg T, Hedelin G, Arveux P: Population-based study of breast cancer survival in Cote d'Or (France): prognostic factors and relative survival. Ann Oncol 2008, 19:276-283.
• [7]Andrieu JM, Colonna P: Cancers: évaluation, traitement et surveillance. Ed ESTEM, Paris; 1997.
• [8]DiGiovanna MP: Clinical significance of HER-2/neu overexpression: Part I. In Principles and practice of oncology. volume 13. 9th edition. Edited by DeVita VT Jr, Hellman S, Rosenberg SA. Lippincott Williams & Wilkins Cedar Knolls, NJ; 1999.
• [9]Huiart L, Bardou V-J, Puig B, Maraninchi D: Improvement in breast cancer survival between 1975 and 2003 in a cohort of 5722 women. Bull Cancer 2006, 93:391-399.
• [10]Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thürlimann B, Senn H-J, Panel members: Thresholds for therapies: highlights of the St Gallen intenational expert consensus on the primary therapy of early breast cancer 2009. Ann Oncol 2009, 20:1319-1329.
• [11]Maraninchi D, Cerf N, Bousquet P, Lequellec-Nathan M, Danzon A, Belot A, Thuret A, Jougla E, Rey G, Grosclaude P, Colonna M, Bossard N, Canet C, Vongmany N: Dynamique d’évolution des taux de mortalité des principaux cancers en France. INCa; 2010:p42. http://www.e-cancer.fr/component/docman/doc_download/5986-dynamique-devolution-des-taux-de-mortalite-des-principaux-cancers-en-france-novembre-2010 webcite
• [12]Grosclaude P, Colonna M, Hedelin G, Tretarre B, Arveux P, Lesec’h JM, Raverdy N, Sauvage-Machelard M: Survival of women with breast cancer in France: variation with age, stage and treatment. Breast Cancer Res Treat 2001, 70:137-143.
• [13]Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schäfer P, Kurtz J, Sappino A-P, Vlastos G: Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 2003, 21:3580-3587.
• [14]Van Leeuwen BL, Rosenkranz KM, Lei Feng L, Bedrosian I, Hartmann K, Hunt KK, Kuerer HM, Ross M, Singletary SE, Babiera GV, the Department of Surgical Oncology, MD Anderson Cancer Center: The effect of under-treatment of breast cancer in women 80 years of age and older. Crit Rev Oncol Hematol 2011, 79:315-320.
• [15]Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, Wheeler J, Champion LA, Smith TJ, Smith BL, Shapiro C, Muss HB, Winer E, Hudis C, Wood W, Sugarbaker D, Henderson IC, Norton L: Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 2004, 351:971-977.
• [16]Early Breast Cancer Trialists’ Collaborative Group (EBCTCG): Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005, 365:1687-1717.
• [17]Mandelblaltt J, Kreling B, Figeuriedo M, Feng S: What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 2006, 24:4908-4913.
• [18]Bouchardy C, Rapiti E, Blagojevic S, Vlastos A-T, Vlastos G: Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol 2007, 25:1858-1869.
• [19]Giordano SH, Hortobagyi GN, Kau S-WC, Theriault RL, Bondy ML: Breast cancer treatment guidelines in older women. J Clin Oncol 2005, 23:783-791.
• [20]Faivre J, Lemmes VEPP, Quipourt V, Bouvier AM: Management and survival of colorectal cancer in the elderly in population based-studies. Eur J Cancer 2007, 43:2279-2284.
• [21]Sobin LH, Wittekind C (Eds): International Union Against Cancer (UICC): TNM classification of malignant tumors. 5th edition. John Wiley & Sons, Inc, New York, NY; 1997.
• [22]Ederer F, Axtell LM, Cutler SJ: The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 1961, 6:101-121.
• [23]Dickman PW, Sloggett A, Hills M, Hakulinen T: Regression models for relative survival. Stat Med 2004, 23:51-64.
• [24]Bastiaannet E, Portielje JEA, Van de Velde CJH, Craen AJM, Van der Velde S, Kuppen PJK, Van der Geest LGM, Janssen-Heijnen MLG, Dekkers OM, Westendorp RGJ, Liefers G-J: Lack of survival gain for elderly women with breast cancer. Oncologist 2011, 16:415-423.
• [25]Land LH, Dalton SO, Jørgensen TL, Ewertz M: Comorbidity and survival after early breast cancer. A review. Crit Rev Oncol Hematol 2011, 81:196-205.
• [26]Berrino F, De Angelis R, Sant M, Rosso S, Lasota MB, Coebergh JW, Santaquilani M, EUROCARE working group: Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007, 8:773-783.
• [27]Weggelaar I, Aben KK, Warlé MC, Strobbe LJ, Van Spronsen DJ: Declined guideline adherence in older breast cancer patients: a population-based study in The Netherlands. Breast J 2011, 17:239-245.
• [28]Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP: Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 2010, 28:2038-2045.
• [29]NIH consensus statement: adjuvant therapy for breast cancer. http://consensus.nih.gov/2000/2000AdjuvantTherapyBreastCancer114PDF.pdf webcite