Prognosis and Adjusting Factors in Elderly Patients With Triple-Negative Breast Cancer: Comparing With Young and Middle Age Groups

Yong Ho You; Min Kyoon Kim; Joo Yun Lee

doi:10.1016/j.clbc.2024.01.016

Prognosis and Adjusting Factors in Elderly Patients With Triple-Negative Breast Cancer: Comparing With Young and Middle Age Groups

Clin Breast Cancer. 2024 Jan 30:S1526-8209(24)00027-2. doi: 10.1016/j.clbc.2024.01.016. Online ahead of print.

Authors

Yong Ho You¹, Min Kyoon Kim², Joo Yun Lee³

Affiliations

¹ Department of Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea.
² Department of Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea. Electronic address: minkyoon96@cau.ac.kr.
³ College of Nursing, Gachon University, Yeonsu-gu, Incheon, Republic of Korea. Electronic address: jooyun@gachon.ac.kr.

PMID: 38413338
DOI: 10.1016/j.clbc.2024.01.016

Abstract

Purpose: Proper breast cancer screening and treatment should be considered in the elderly population; however, some tend to be less proactive. Our study aimed to investigate the impact of old age on treatment and prognosis in triple-negative breast cancer (TNBC).

Method: The study included patients with primary TNBC stage I-III diagnosed from 2002 to 2019 in single institution and retrospectively analyzed. We defined young (< 40 years), middle and old (> 70 years) groups. Clinicopathological factors, treatment, and prognosis were analyzed according to age group of TNBC patients.

Result: TNBC patients aged 70 and above were 3.3 times more likely (P = .019) to have lymph node metastasis at the time of diagnosis compared to younger patients, but were found to be 0.24 times less likely to receive chemotherapy. (P = .003) Old TNBC patients have an expected likelihood 2.2 times higher of undergoing mastectomy rather than breast-conserving surgery. (P = .042) The 5-year prognosis is poorer in young and old group. (61%, 86%, and 65% in young, middle, and old groups). (P < .001). In subanalysis, old group of stages I and II received fewer chemotherapy compared to youngers (P < .05), but not in stage III. In Cox regression analysis, age and stage had significant impact on prognosis (hazard ratio 2-3), but treatment factors did not. However, in stratified analysis of adjuvant therapy and stage, prognosis of Old TNBC patients in stage II was improved when they underwent neo or adjuvant chemotherapy.

Conclusion: TNBC presents challenges in older patients, who receive less aggressive treatment and have poorer outcomes. The primary cause of poor prognosis in old TNBC patients is the high disease stage at diagnosis, underscoring the need for promotion and education on early screening. Additionally, it is suggested that a more proactive approach to adjuvant chemotherapy is necessary for stage II old TNBC patients.

Keywords: Adjuvant Chemotherapy; Age Discrepancies; Early Screening; Survival; Treatment Disparities.