title: Outcomes After Mastectomy and Lumpectomy in Elderly Patients with Early-Stage Breast Cancer.
abstract: BACKGROUND
  Survival in elderly patients undergoing mastectomy or lumpectomy has not been specifically analyzed.
  
  
  METHODS
  Patients older than 70 years of age with clinical stage I invasive breast cancer, undergoing mastectomy or lumpectomy with or without radiation, and surveyed within 3 years of their diagnosis, were identified from the Surveillance, Epidemiology, and End Results and medicare health outcomes survey-linked dataset. The primary endpoint was breast cancer-specific survival (CSS).
  
  
  RESULTS
  Of 1784 patients, 596 (33.4 %) underwent mastectomy, 918 (51.4 %) underwent lumpectomy with radiation, and 270 (15.1 %) underwent lumpectomy alone. Significant differences were noted in age, tumor size, American Joint Committee on Cancer (AJCC) stage, lymph node status (all p < 0.0001) and number of positive lymph nodes between the three groups (p = 0.003). On univariate analysis, CSS for patients undergoing lumpectomy with radiation [hazard ratio (HR) 0.61, 95 % confidence interval (CI) 0.43-0.85; p = 0.004] was superior to mastectomy. Older age (HR 1.3, 95 % CI 1.09-1.45; p = 0.002), two or more comorbidities (HR 1.57, 95 % CI 1.08-2.26; p = 0.02), inability to perform more than two activities of daily living (HR 1.61, 95 % CI 1.06-2.44; p = 0.03), larger tumor size (HR 2.36, 95 % CI 1.85-3.02; p < 0.0001), and positive lymph nodes (HR 2.83, 95 % CI 1.98-4.04; p < 0.0001) were associated with worse CSS. On multivariate analysis, larger tumor size (HR 1.89, 95 % CI 1.37-2.57; p < 0.0001) and positive lymph node status (HR 1.99, 95 % CI 1.36-2.9; p = 0.0004) independently predicted worse survival.
  
  
  CONCLUSIONS
  Elderly patients with early-stage invasive breast cancer undergoing breast conservation have better CSS than those undergoing mastectomy. After adjusting for comorbidities and functional status, survival is dependent on tumor-specific variables. Determination of lymph node status remains important in staging elderly breast cancer patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Harveshp D
authors.initials: HD
authors.lastname: Mogal
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Clancy
authors.initials: C
authors.lastname: Clark
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dodson
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. mmcnatt@wakehealth.edu.
authors.forename: Marissa
authors.initials: M
authors.lastname: Howard-McNatt
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden