Long-term clinical outcome of oestrogen receptor-positive operable primary breast cancer in older women: A large series from a single centre

Abstract

Introduction:A Cochrane review of seven randomised trials (N1571) comparing surgery and primary endocrine therapy (PET) (oestrogen receptor (ER) unselected) shows no difference in overall survival (OS). We report outcome of a large series with ER-positive (ER) early invasive primary breast cancer.Methods:Between 1973 and 2009, 1065 older (70 years) women (median age 78 years (70-99)) had either surgery (N449) or PET (N616) as initial treatment.Results:At 49-month median follow-up (longest 230 months), the 5-year breast cancer-specific survival (BCSS) and OS were 90 and 62%, respectively. Majority (74.2%) died from causes other than breast cancer. The rates (per annum) of local/regional recurrence (1%) (following surgery), contralateral tumour (1%) and metastases (3%) were low. For patients on PET, 97.9% achieved clinical benefit (CB) at 6 months, with median time to progression of 49 months (longest 132 months) and significantly longer BCSS when compared with those who progressed (P0.001). All patients with strongly ER (H-score 250) tumours achieved CB and had better BCSS (P0.01). Patients with tumours having an H-score 250 were found to have equivalent BCSS regardless of treatment (surgery or PET; P0.175), whereas for those with H-score 250, surgery produced better outcome (P0.001).Conclusion:Older women with ER breast cancer appear to have excellent long-term outcome regardless of initial treatment. Majority also die from non-breast cancer causes. Although surgery remains the treatment of choice, patients with ER-rich (H-score 250) tumours tend to do equally well when treated by PET. This should be taken into account when therapies are considered. © 2011 Cancer Research UK All rights reserved.