Prognostic impact of breast cancer subtypes in elderly patients.
We aimed to analyse the impact of breast cancer (BC) subtypes on the clinical course of disease with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly BC population. A total number of 706 patients ≥65 years receiving treatment for BC from 2007 to 2011 were identified from a BC database. 62 patients diagnosed with DCIS and 73 patients with incomplete datasets were excluded, leaving 571 patients for this analysis. Patient characteristics, biological tumour subtypes, and clinical outcome including overall survival (OS) were obtained by retrospective chart review. 380/571 (66, 5 %) patients aged 65-74 years were grouped among the young-old, 182/571 (31.9 %) patients aged 75-84 years among the old-old, and 29/571 (5.1 %) patients aged ≥85 years among the oldest-old. 392/571 (68.8 %) patients presented with luminal BC, 119/571 (20.8 %) with HER2-positive, and 59/571 (10.3 %) with triple-negative BC (TNBC). At 38 months median follow-up, 115/571 (20.1 %) patients presented with distant recurrence. A higher recurrence rate was observed in the HER2-positive subtype (43/119 (36.1 %)), as compared to TNBC (15/59 (25.4 %)) and luminal BC (57/392 (14.5 %); p < 0.001). BM were detected at a significantly higher rate in HER2-positive BC patients (9/119 (7.6 %)), as compared to TNBC (2/59 (3.4 %)) and luminal BC patients (6/392 (1.5 %); p = 0.003). Diagnosis of metastatic disease (HR 7.7; 95 % CI 5.2-11.4; p < 0.001) as well as development of BM (HR 3.5; 95 % CI 1.9-6.4; p < 0.001) had a significantly negative impact on OS in a time-dependent covariate cox regression model. In contrast to younger BC patients, outcome in this large cohort of elderly patients suggests that HER2-positive disease-not TNBC-featured the most aggressive clinical course with the highest rates of metastatic spread and BM. In-depth analysis regarding a potentially distinct biology of TNBC in elderly is therefore warranted.
Comprehensive Cancer Center, Vienna, Austria. elisabeth.bergen@meduniwien.ac.at.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria. elisabeth.bergen@meduniwien.ac.at.
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Bergen
Comprehensive Cancer Center, Vienna, Austria.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Tichy
Comprehensive Cancer Center, Vienna, Austria.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Berghoff
Comprehensive Cancer Center, Vienna, Austria.|Department of Pathology, Medical University of Vienna, Vienna, Austria.
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Rudas
Comprehensive Cancer Center, Vienna, Austria.|Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Dubsky
Comprehensive Cancer Center, Vienna, Austria.|Department of Pathology, Medical University of Vienna, Vienna, Austria.
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Bago-Horvath
Comprehensive Cancer Center, Vienna, Austria.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Mader
Comprehensive Cancer Center, Vienna, Austria.|Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Exner
Comprehensive Cancer Center, Vienna, Austria.|Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Gnant
Comprehensive Cancer Center, Vienna, Austria.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Zielinski
Comprehensive Cancer Center, Vienna, Austria.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Steger
Comprehensive Cancer Center, Vienna, Austria.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Preusser
Comprehensive Cancer Center, Vienna, Austria. rupert.bartsch@meduniwien.ac.at.|Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria. rupert.bartsch@meduniwien.ac.at.
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Bartsch
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary*; D001943:Breast Neoplasms / Q000145:classification* / Q000378:metabolism / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D012189:Retrospective Studies
D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
Brain metastases; Elderly patients; HER2-positive breast cancer; Metastatic breast cancer; Risk factors; Triple-negative disease