The treatment outcomes and the use of adjuvant therapies in breast cancer patients with severe co-morbidities.
OBJECTIVE
Studies have suggested a potential role of patient's co-morbidity in determining the survival outcomes of breast cancer. In this study, we examined the long-term oncologic outcomes in breast cancer patients who underwent curative surgery according to their pre-existing comorbid conditions and analyzed the association between the co-morbidity and the use of adjuvant therapies.


METHODS
The medical records of 2,501 patients who underwent surgery for primary breast cancer from June 2006 to June 2010 were reviewed retrospectively. The patients were classified into three groups according to preoperative ASA status determined by the anesthesiologists. Clinico-pathologic characteristics and survival outcomes of the patients were compared among the different co-morbidity groups.


RESULTS
There were 1,792 (71.6%), 665 (26.6%), and 44 (1.8%) patients in ASA I, II, and III, respectively. Total 95 (3.8%) deaths and 269 (10.8%) recurrences (loco-regional and distant) occurred during the median follow-up period of 71 months. Patients with high comorbidity showed significantly higher rate of deaths (51 (2.8%), 38 (5.7%) and 6 (13.6%) deaths in ASA I, II and III group, respectively, p<0.001). The ASA 3 patients also showed significantly higher rate of breast cancer recurrence when compared to other groups (180 (10.0%), 80 (12.0%) and 9 (20.5%) in ASA I, II, and III, respectively, p = 0.041). Significantly fewer patients in the high co-morbidity group received adjuvant therapies (77 (4.3%), 44 (6.6%) and 8 (18.2%) in ASA I, II, and III, respectively, p<0.001). The increased recurrence of breast cancer in the high morbidity group was mostly seen in patients who did not receive adjuvant therapies. The incidence of serious adverse effect during the adjuvant therapy did not differ according to the co-morbidity conditions.


CONCLUSIONS
In this study, high comorbidity was related to increased risk of death and recurrence in breast cancer. The increased risk of recurrence in high co-morbidity group was mostly seen in patients who did not receive adjuvant therapies. Considering the relatively low rates of serious adverse effects in high co-morbidity patients who received adjuvant therapies, active use of adjuvant therapies in selected patients may improve survival outcomes in breast cancer patients with severe co-morbidities.
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jaihong
J
Han
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Han-Byoel
HB
Lee
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Eun-Shin
ES
Lee
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Young Joon
YJ
Kang
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Yumi
Y
Kim
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jihye
J
Choi
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jiyoung
J
Rhu
Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Hee-Chul
HC
Shin
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Wonshik
W
Han
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Dong-Young
DY
Noh
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Hyeong-Gon
http://orcid.org/0000-0002-9981-0286
HG
Moon
D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003131:Combined Modality Therapy; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D016896:Treatment Outcome