Prognostic Factors for Elderly Breast Cancer Patients in University Malaya Medical Centre, Malaysia

Background: Information about elderly breast cancer patients’ outcome is limited. This study aimed to evaluatethe treatment outcomes in women aged 70 and above with specific analysis on prognostic clinicopathologicalfeatures and treatment modalities. Materials and
Methods: This retrospective study examined breast cancerpatients between 1st January 1994 and 31st December 2004 in UMMC. Survival analysis was performed usingthe Kaplan-Meier method and comparisons between groups using the log-rank test. Univariate and multivariateanalysis on prognostic factors were carried out using the Cox’s proportionate hazard model for patientdemographics, and tumour and treatment factors.
Results: One hundred and thirty six patients were identified,with a median age at diagnosis of 75 years. Most had at least one co-morbidity (61.8%). Only 75.0% had a goodperformance status (ECOG 0-1). Mean tumour size was 4.4cm. Primary tumour stages (T stages) 3 and 4 werepresent in 8.1% and 30.1% of patients respectively, and 30.9% had stage III and 8.8% had stage IV disease basedon overall AJCC staging. ER positivity was 58.1%. PR status was positive in 30.1%. Surgery was performed in69.1% of the patients and mastectomy and axillary clearance were the commonest surgical procedures (50.7%).Some 79.4% of patients received hormonal therapy, 30.1% radiotherapy and only 3.6% chemotherapy. Nonstandardtreatment was given to 39.0% of patients due to a variety of reasons. The cumulative 5 years overall,relapse free and cause specific survivals were 51.9%, 79.7% and 73.3% respectively. Performance status, T3-4tumour, presence of metastasis, tumour grade and ER status were independent prognostic factors for overallsurvival. For cause specific survival they were T4 tumour, presence of metastasis and ER status.
Conclusion:The 5 years overall survival rate was 51.9% and 41.8% of deaths were non-breast cancer related deaths. Lowsurvival rate was related to low life expectancy in this population. Locally advanced disease, metastatic diseaseand high ER negative rates play a major role in the survival of elderly breast cancer patients in Malaysia.