Abstract
Objective: The optimal management of early-stage breast cancer in elderly patients remains challenging due to age-related comorbidities, limited life expectancy, and underrepresentation in clinical trials. This study aimed to evaluate the impact of adjuvant treatment preferences on survival outcomes in women aged 65 years and older with early-stage, node-negative, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer.
Material and Methods: In this retrospective cohort study, 157 patients aged ≥65 years who underwent surgery between 2003 and 2022 were analyzed. Patients were categorized into two groups according to adjuvant treatment strategy: chemotherapy (CT) followed by hormonal therapy (HT), or HT alone. Clinicopathological characteristics, comorbidities, relapse-free survival (RFS), and overall survival (OS) were compared between groups. Survival outcomes were assessed using Kaplan-Meier analysis, and prognostic factors were evaluated using univariate and multivariate Cox proportional hazards regression models, including clinically relevant variables.
Results: Of the 157 patients, 49 (31.2%) received CT followed by HT, and 108 (68.8%) received HT alone. Patients treated with HT alone were significantly older and had smaller tumors and earlier-stage disease. Despite these favorable tumor characteristics, OS was significantly lower in the HT group compared with the CT group (p=0.003). No significant difference in RFS was observed between the groups (p=0.782). In multivariate analysis of OS, age [hazard ratio (HR): 1.17; 95% CI: 1.08-1.26; p<0.001] and multicentricity (HR: 6.51; 95% CI: 2.16-19.64; p=0.001) were independently associated with worse survival, while the treatment group was not independently associated with survival after adjustment. In multivariate analysis of RFS, age (HR: 1.24; 95% CI: 1.10-1.39; p<0.001) and the Charlson comorbidity score (HR: 2.07; 95% CI: 1.04-4.14; p=0.038) were independently associated with recurrence.
Conclusion: In elderly patients with early-stage hormone receptor-positive breast cancer, survival outcomes appear to be influenced more strongly by age and comorbidity burden than by treatment choice alone. While HT is frequently preferred, adjuvant CT may still be considered in carefully selected patients. A personalized, multidisciplinary approach is essential to optimize treatment decisions in this population.