Selective application of axillary node dissection in elderly women with early breast cancer.
BACKGROUND
Routine use of axillary lymph node dissection (ALND) has been questioned in elderly women. This study examines whether selective application of ALND in early stage breast cancer affects breast cancer-related survival.


METHODS
From the Surveillance, Epidemiology, and End Results (SEER) database, records of women >or=70 years of age with stage I or II breast cancer diagnosed between 1990 and 1995 were reviewed. Hazard ratios (HR) of cause-specific survival (CSS) between women receiving ALND and those who did not were compared. To minimize the potential for bias in the selection of women to receive ALND, HR of CSS was compared within propensity analysis deciles.


RESULTS
20,151 women entered the analysis. Median follow up was 6 years (interquartile range 4.33-7.67 years). Seventy-five percent underwent ALND. Women with higher risk disease and younger age were more likely to undergo ALND. Five year unadjusted CSS in women who did and did not receive ALND was 92.1% and 90.6%, respectively, with a HR of 0.85, P = 0.002. Using the propensity analysis method, the adjusted HR for CSS associated with ALND was 0.89, P = 0.066.


CONCLUSIONS
After adjusting for differences in the probability of receiving ALND, no clinically or statistically significant difference in survival was observed among women who received ALND when compared with those who did not, although we could not account for differences in co-morbidity or use of systemic therapy between groups.


CONCLUSIONS
Surgeons select elderly women with early stage breast cancer for ALND with a negligible impact on CSS.
Aziz
Dalal
D
Department of Surgery, University of Toronto, 100 College Street, M5G 1L5, Toronto, Canada.
Gardner
Sandra
S
Pritchard
Kathleen
K
Paszat
Lawrence
L
Holloway
Claire M B
CM
D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D018426:SEER Program; D016019:Survival Analysis; D014481:United States