Determinants of outcome in elderly patients with positive sentinel lymph nodes

Karam, Amer K.; Hsu, Meier; Patil, Sujata; Stempel, Michelle; Traina, Tiffany A.; Ho, Alice Y.; Cody, Hiram S.; Morrow, Monica; Gemignani, Mary L.

doi:10.1016/j.amjsurg.2010.02.005

« Previous Next »The American Journal of Surgery
Volume 201, Issue 6 , Pages 734-740, June 2011

Determinants of outcome in elderly patients with positive sentinel lymph nodes

Amer K. Karam, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E. 66th St, New York, NY 10065, USA
Meier Hsu, M.S.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E. 66th St, New York, NY 10065, USA
Sujata Patil, Ph.D.
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Michelle Stempel, M.S.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E. 66th St, New York, NY 10065, USA
Tiffany A. Traina, M.D.
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Alice Y. Ho, M.D.
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Hiram S. Cody, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E. 66th St, New York, NY 10065, USA
Monica Morrow, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E. 66th St, New York, NY 10065, USA
Mary L. Gemignani, M.D., M.P.H.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E. 66th St, New York, NY 10065, USA
- Corresponding author. Tel.: +1-646-888-5359; fax: +1-646-888-5365

Received 23 September 2009; received in revised form 23 January 2010 published online 09 July 2010.

Abstract

Background

Older women are less likely to receive standard of care treatment for breast cancer.

Methods

We examined variables that affected the outcome of elderly patients ≥70 years old among 1,470 patients with invasive cancer with positive sentinel lymph nodes (SLNs).

Results

Elderly patients were less likely to undergo mastectomy, completion axillary node dissection (ALND), adjuvant chemotherapy, and radiotherapy (RT) following breast-conserving therapy (BCT) compared with patients <70 years old. The 5-year risk of disease progression and cumulative incidence of breast cancer–specific deaths were not significantly different for both groups. On multivariate analysis, hormone receptor–negative status, number of metastatic lymph nodes, high nuclear grade, and tumor size were the factors independently associated with increased risk of disease progression.

Conclusions

Tumor factors were the primary determinants of breast cancer outcomes in our cohort. Elderly patients are less likely to receive aggressive surgical interventions and adjuvant therapy because of perceived life expectancy.

Keywords: Elderly patients, Sentinel lymph nodes, Lymph nodes, Outcomes