Primary treatment strategy in elderly patients with hormone receptor positive early breast cancer: is breast cancer surgery.

Background: Older age, ECOG performance status, major comorbidities and concomitant medications influence the primary treatment strategy of hormone receptor positive (HR+) early breast cancer (EBC) patients. In case of frail patients, oncologist may choose primary endocrine therapy (ET) instead of breast cancer surgery (BCS) even if its clinical impact is still unknown. Methods: We performed a retrospective study on women aged 75 years and older with HR+ EBC diagnosed at the Modena Cancer Center from 2010 to 2016. According to primary treatment strategy patients were divided into two groups: patients who underwent BCS (BCS group) versus patients treated with only ET (ET group). Patients’ clinical data and tumor characteristics were collected. Disease Free Survival (DFS) and Breast cancer-specific survival (BCSS) were estimated by long rank test and Kaplan-Meier curves. Results: 143 patients were involved in the study: 105 in BCS group and 38 in ET one. Patients who underwent surgery had significantly better ECOG (p=0.000001), low tumour grade (p=0.04) and early clinical stage (p=0.0001) compared to those in the ET group. In patients with negative lymph-nodes at the diagnosis, tumor stage I-II and low ki67 (<20%), BCS did not improve 5-years DFS in univariate and multivariate analysis (p = 0.099, 95%CI 0.152-1.175). No differences were found in terms of 5-years BCSS between the two groups (p = 0.195). Conclusions: Stage I-II at the diagnosis, negative axillary lymph nodes and low ki67 identified a subgroup of HR+ EBC patients aged > 75 with low risk of disease progression who may not benefit from primary BCS. In elderly frail patients, primary ET instead of BCS could be a valid treatment strategy that should be considered on a case-bycase basis.