Analysis Of Clinicopathological Features And Prognostic Factors In Different Age-groups Of Old Women With Breast Cancer Based On A SEER Database

Background&objective:Breast cancer is a worldwide disease and the number of old patients is increasing.Few studies focused on clinicopathological features in different age groups of old patients.Therefore,we aim to investigate its association and explore the prognostic factors in elderly patients.Methods:We utilized the U.S.National Cancer Institute’s Surveillance,Epidemiology,and End Results(SEER)database to identify 166481 female breast cancer patients older than 60 years from 1990 to 2013.The age of patients at diagnosis was treated as a categorical variable to investigate its effect on Breast cancer-specific survival(BCSS):60-64 years,65-69 years,70-74 years,75-79 years,80-84 years,and older than 85 years.We also recorded and analyzed clinicopathological data of these age-groups.The Kaplan-Meier plots and the Cox proportional hazards model were used to investigate BCSS among old patients.Further analyses were stratified joint with hormone receptor(HoR)and lymph node status.Results:These study findings showed that many factors were associated with patient survival,including age,year of diagnosis,marital status,race,lymph node status,TNM-stage,hormone status,radiation and tumor sites.Moreover,age had an important prognostic effect on determining BCSS in elderly patients and the hazard ratio(HR)for BCSS decreased with increasing age(65-69 years:HR=1.089,95%CI,1.038-1.142,P<0.001;70-74 years:HR=1.219,95%CI,1.161-1.281,P<0.001;75-79 years:HR=1.439,95%CI,1.366-1.515,P<0.001;80-84 years:HR=1.750,95%CI,1.651-1.855,P<0.001;>85 years:HR=2.298,95%CI,2.145-2.461,P<0.001).In entire population,patients aged from 60 to 64 years had the best survival while patients older than 80 years had worse outcome and patients more than 85 years old had the worst survival.All results mentioned above were confirmed by calculating 5 year-BCSS and 10 year-BCSS.In the subgroup of ER(-)PR(+),we found 65-69 years-old patients(5-BCSS:86.9%,10-BCSS:81.2%)had better survival rate than 60-64 years-old patients(5-BCSS:84.4%,10-BCSS:79.3%).Furthermore,all patients in N3-groups had worse outcome.The prognostic value of age was different from the role of nottingham prognostic index(NPI).Conclusion:There is a significant difference of clinicopathological features in different age-groups and age at diagnosis has a great role in evaluating patient survival of elderly breast cancer both in the entire population and in the subgroups stratified by HoR or lymph node status.Patients aged from 60 to 64 years old have the best survival,while patients more than 80 years old have worse outcome.Indeed,patients older than 85 years old have the worst survival as expected.Moreover,the prognostic effect of age does not accord with the role of NPI and age may have more efficacy in determining patient BCSS than NPI.