Long term efficacy of adjuvant chemotherapy in elderly patients with early stage breast cancer assessed through SEER database analysis
Abstract Current guidelines lack definitive recommendations on the use of chemotherapy for early-stage breast cancer in patients aged over 70. Clinical decision-making on chemotherapy for elderly breast cancer remains challenging because of insufficient large-scale, long-term outcomes. We conducted...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-07-01
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| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-03592-6 |
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| Summary: | Abstract Current guidelines lack definitive recommendations on the use of chemotherapy for early-stage breast cancer in patients aged over 70. Clinical decision-making on chemotherapy for elderly breast cancer remains challenging because of insufficient large-scale, long-term outcomes. We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results database from 2010 to 2020 to investigate early-stage breast infiltrating ductal carcinoma in patients aged 70 to 79. Propensity score matching (PSM) with a ratio of 1:1 and caliper of 0.02 standard deviation of propensity score was employed to address covariate imbalance. Univariate and multivariate analyses were performed to assess the impact of chemotherapy on breast cancer-specific survival (BCSS) and overall survival (OS). We identified a total of 11,792 patients with complete information about breast cancer, who underwent surgical treatment and received systemic therapy after surgery. Among them, 3,490 patients received chemotherapy. After PSM, we obtained a matched cohort consisting of 3,156 patients where the characteristics between the two groups were balanced except for molecular subtypes. In the matched dataset, no significant differences were observed in BCSS (P = 0.118) and OS (P = 0.119) between the two groups based on Kaplan–Meier survival analysis. Similarly, multivariate COX analysis revealed that chemotherapy did not significantly reduce the risk of BCSS (HR: 1.212; 95% CI: [0.958–1.533], P = 0.109) and OS (HR: 0.888; 95% CI: [0.765–1.031], P = 0.12). Stratified analyses based on molecular subtypes revealed that chemotherapy did not confer a favorable prognosis in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2(HER2)-negative breast cancer in stages I and IIa, as well as in patients with HR+HER2+ breast cancer in stages I. Chemotherapy may not confer a discernible benefit for all elderly patients with breast cancer. Nevertheless, de-escalating chemotherapy could be considered as a preferable alternative for older individuals diagnosed with HR+HER2- breast cancer in stages I and IIa or HR+HER2+ breast cancer in stages I. |
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| ISSN: | 2045-2322 |