Local Recurrence Lowered With Immediate Surgery in Elderly Patients With Breast Cancer

Immediate surgery for elderly patients with breast cancer lowered local recurrence rates compared to delayed surgery.

In elderly patients with breast cancer, receiving immediate surgery demonstrated significant reductions in local recurrence compared with delaying surgery following disease progression (worsening), according to findings from an analysis presented at the 2024 San Antonio Breast Cancer Symposium (SABCS).

Among 656 patients with node-negative disease, the rate of isolated local recurrence at five years was 45.4% for those who received Soltamox (tamoxifen) alone versus 14.4% for patients who received Soltamox in combination with surgery. For 262 patients with node-positive disease, the five-year rates of isolated local recurrence were 48.1% versus 6.8% in each respective group. Data showed that characteristics such as tumor size or trial did not impact local recurrence outcomes achieved with immediate surgery.

In the Soltamox alone and Soltamox-surgery groups, respectively, the rates of distant recurrence were 24.4% versus 20.7% at five years, 39.5% versus 30.9% at 10 years and 51.3% versus 37% at 15 years. In each respective group, the rates of breast cancer mortality were 16.0% versus 11.9% at five years, 33.6% versus 25.9% at 10 years and 48.9% versus 34.2% at 15 years. Findings showed that immediate surgery conferred little effect on distant recurrence or breast cancer mortality outcomes compared with Soltamox alone within one year of treatment.

The rates of all-cause mortality with Soltamox alone and Soltamox-surgery, respectively, were 31.8% versus 26.1% at five years, 65.8% versus 61.8% at 10 years and 88.7% versus 82.2% at 15 years. Overall, investigators noted that were was no evidence of immediate surgery producing any effect on non-breast cancer mortality.

“In the absence of radiotherapy, we see that immediate compared with deferred surgery greatly reduces local recurrence. This benefit in local recurrence translates into a later difference in distant recurrence and breast cancer [mortality], but it’s only apparent with long follow-up," study author Robert Hills stated in the presentation. “The results will be greatly [supplemented] by the updated analysis of the NSABP B-06 trial of mastectomy versus lumpectomy.”

Hills is a professor of Medical Statistics in the Nuffield Department of Population Health at the University of Oxford and head of the Secretariat for the Early Breast Cancer Trialists’ Collaborative Group.

According to Hills, rates of surgery tend to diminish as patients with breast cancer become older, especially among individuals above the age of 80 years. With this background in mind, investigators aimed to assess whether immediate surgery plus Soltamox improved outcomes among elderly patients with breast cancer compared with delaying surgery until patients experience progressive disease.

Investigators conducted a patient-level meta-analysis of data on 1,082 individuals with breast cancer who were 70 years and older across three clinical trials evaluating immediate surgery versus deferral in the absence of radiotherapy. Patients included in the analysis remained on the study for a median of five years.

The main outcomes of the analysis were local recurrence, distant recurrence and mortality.

“These results are relevant today, methodologically, because what they tell us is that even with large differences in local therapy — surgery versus no surgery — the benefits only occur with longer follow-up,” Hills concluded. “Trials that compare local therapy or screening need to be followed up for long enough to see whether any benefits emerge.”

Reference:

“Immediate breast surgery versus deferral of surgery in women aged 70+ years with operable breast cancer: patient-level meta-analysis of the three randomised trials among 1,082 women” by Robert Hills, et al. Presented at the 2024 San Antonio Breast Cancer Symposium; December 10-13, 2024; San Antonio, TX. LB1-01.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.