Cancers | Free Full-Text | Survival Outcomes in Older Women with Oestrogen-Receptor-Positive Early-Stage Breast Cancer: Primary Endocrine Therapy vs. Surgery by Comorbidity and Frailty Levels
To address this knowledge gap, this study aimed to compare all-cause (ACM) and breast cancer-specific mortality (BCSM) associated after PET and surgery in older women (aged ≥ 70 years) with newly diagnosed early-stage oestrogen-receptor-positive breast cancer at different frailty and comorbidity levels. Rigorous examination and sensitivity analysis were conducted to inform appropriate treatment approaches for this patient cohort.
In contrast to the existing body of literature, our study offers a comprehensive investigation into the relative clinical effectiveness of PET versus surgical interventions among elderly female patients, stratified across varying levels of physical functioning (using CCI and HFRS). Our research addresses a notable gap in the current knowledge landscape by leveraging population-based data. These findings constitute a valuable resource for clinicians seeking evidence-based insights to guide treatment optimisation for older women diagnosed with early-stage oestrogen-receptor-positive (ER+) breast cancer, particularly in varying levels of frailty and comorbidity.
This study had some strengths. Firstly, it evaluates the clinical efficacy of PET and surgical interventions utilising a high-quality UK primary care database and enriching its coverage through linkage with cancer registry records, secondary care data, socioeconomic indices, and death certificates. This extensive data integration strategy enhances the study’s sample size, assuring excellent statistical power (>99%). Secondly, the investigation encompasses two pivotal outcome measures to inform clinical decision-making: overall survival (OS) and breast cancer-specific mortality (BCSM). Furthermore, the sensitivity analysis considered competing risks, fortifying the results’ robustness and reliability.
Finally, this study defined PET and surgery as the initial treatment strategies, irrespective of the subsequent treatment received. Some older female patients who initially received PET might also receive surgery when their breast cancer progressed. However, post-progression management is a different clinical decision problem than early-stage breast cancer management upon diagnosis. To minimise misclassification bias in this study, patients who received PET and then received surgery after one year were excluded from the study cohort.
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