The effect of treatment preferences on survival in early stage breast cancer in elderly patients over 65 years of age

The effect of treatment preferences on survival in early stage breast cancer in elderly patients over 65 years of age | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of treatment preferences on survival in early stage breast cancer in elderly patients over 65 years of age Esma Uguztemur, Derya Kivrak Salim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5633887/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The increasing incidence and mortality of breast cancer with age remains a major health concern, particularly in the elderly population. However, the under-representation of older patients in clinical trials complicates our understanding of the characteristics of this population. In this retrospective study, we evaluated breast cancer patients aged 65 years and older with early-stage hormone receptor-positive, HER2-negative disease. Method A total of 157 patients were included in the study. We compared groups who received postoperative chemotherapy or hormonal therapy, and evaluated several clinical and pathological factors.Factors affecting relapse-free survival (RFS) and overall survival (OS) were evaluated. Results Our results showed a lower overall survival in the hormone therapy group compared to the chemotherapy group. However, this difference suggested the influence of not only the preference for non-aggressive treatments, but also the effect of comorbidities and life expectancy. Analysis of the causes of death showed that coronary heart disease was prominent in the hormone therapy group, suggesting that most deaths were due to causes other than breast cancer recurrence. Conclusions Our results highlight the importance of considering overall health and life expectancy when deciding on treatment options for advanced breast cancer patients. In addition, findings suggesting that aggressive treatments in older patients may provide limited benefit and reduce quality of life emphasise the need for more personalised treatment strategies in this population. Breast cancer elderly hormonal treatment comorbidity Introduction Breast cancer incidence and mortality increase with age, making it a major public health concern, particularly in countries with ageing populations [ 1 ]. However, older patients are often underrepresented in breast cancer treatment trials. It has been observed that breast cancer in this age group tends to be less aggressive, with higher hormone expression, lower grade 3 tumour incidence, lower proliferation markers, etc. [ 2 , 3 ]. On the other hand, the higher prevalence of comorbidities in older women, reduced physical and functional capacity, increases the morbidity associated with both the disease and its treatment [ 4 , 5 ]. Treatment decisions are influenced by age, with less aggressive treatments chosen for older patients [ 6 ]. Factors such as life expectancy and the presence of comorbidities, in addition to the less aggressive nature of breast cancer in the elderly, play a role in this decision-making process. The presence of comorbidities has a direct impact on survival, regardless of age and tumour stage[ 7 ]. Among breast cancer patients aged sixty-five years and older, 13–55% die from causes other than breast cancer [ 8 ]. The standard treatment is surgery for older breast cancer patients who are physically fit and suitable for surgery. Healthy older women tolerate the standard treatment as well as younger patients. Hormone therapy alone may be an option for patients who are ineligible for surgery, but these patients have been shown to have more regional recurrences, requiring more frequent surgery later in life [ 9 , 10 ]. While standard treatment approaches should be applied similarly to young patients, the rates of breast conserving surgery (BCS) and radiotherapy are lower than in younger cases [ 11 ]. Radiotherapy may not be given after breast-conserving surgery in older patients with a low risk of local recurrence. The rate of adjuvant chemotherapy is also lower in elderly breast cancer patients, regardless of tumour size. Sail KR et al reported a significant decrease in the use of chemotherapy with increasing age for different stages. In stage III breast cancer, 49% of patients aged 65–69 years received chemotherapy, whereas this rate decreased to 10% in patients aged 80 years and older[ 12 ]. Elderly breast cancer cases, despite constituting the majority of breast cancer cases, are not included in prospective randomized trials, and information about their treatment is based on retrospective study results and observations. In this study, we aimed to retrospectively evaluate the clinical and pathological characteristics and treatment approaches impact on survival in elderly early-stage breast cancer patients with hormone receptor-positive and HER2-negative tumors. Materials and Methods Between 2003 and 2022, patients aged 65 years and older, diagnosed with early-stage hormone receptor-positive, HER2-negative breast cancer, and no lymph node involvement, who applied to the Medical Oncology Department of Antalya Training and Research Hospital, were retrospectively evaluated. Since chemotherapy would be prioritized for node-positive patients, this group was excluded from the study. Our aim was to evaluate adjuvant treatment preferences, so we also excluded patients who received neoadjuvant therapy. A total of 157 patients were included in the study. The patients were divided into two groups: those who received chemotherapy after surgery and those who received hormonal therapy after surgery. The chemotherapy group also received hormonal therapy following chemotherapy. The pathological and clinical findings were compared, including tumor size, disease stage, tumor location, multifocality, surgical method, radiotherapy, and the Charlson comorbidity score. Factors affecting relapse-free survival (RFS) and overall survival (OS) were also assessed. Statistical Analysis: Statistical analyses were performed using "IBM SPSS Statistics for Windows, Version 25.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA)." Descriptive statistics were presented as n and % for categorical variables and median (IQR) for continuous variables. Mann-Whitney U test was used for the comparison of age, tumor size, and Charlson comorbidity score between treatment groups. Pearson Chi-Square test and Fisher’s Exact test were used for the comparison of categorical variables. Kaplan-Meier method was used to compare survival and RFS times between treatment groups among various clinical parameter groups. Lastly, Univariate and Multivariate Cox Regression results were provided for various clinical factors' impact on the risk of death and RFS. p < 0.05 was considered statistically significant. Results A total of 157 patients were included in the study, excluding patients who received neoadjuvant treatment. After surgery, 108 patients in the hormonal therapy group and 49 patients in the chemotherapy group were compared. The mean age was statistically significantly older in the hormonal therapy group (82 vs 73, p < 0.001). The tumour size was larger in the chemotherapy group and this difference was statistically significant (mean 2.5 cm vs. 1.9 cm, respectively, p = 0.001). While 61.1% of patients in the hormonal therapy group were Stage 1A, 59% of patients in the chemotherapy group were Stage 2A. Chemotherapy was more preferred in advanced-stage diseases, and this was statistically significant (p = 0.004). There was no significant difference between the two groups with regard to grade, histological subtype, ki-67 ratio, E-cadherin, tumour location, multifocality and surgical method. In 71.9% of patients, the tumour was grade 2 and 61% had a ki-67 ratio of less than 20%. Less aggressive tumours were observed in patients aged 65 years and older. While mastectomy with axillary lymph node dissection (MRM + AD/SLND) was preferred in 62.1% of patients, breast conserving surgery with sentinel lymph node dissection (BCS + SLND) was chosen in 37.9% of patients. BCS was not preferred in patients aged 65 years and older. Radiotherapy was given in 49% of patients who received chemotherapy compared to 24.1% of patients who received hormonal therapy, and this difference was statistically significant (p = 0.002). This may be related to the higher rate of MRM and lower stage in this group. The most commonly used treatments in the chemotherapy group were adriamycin + cyclophosphamide (AC) and docetaxel + cyclophosphamide (TC). The most common comorbidities in both groups were diabetes mellitus and hypertension, with 37.6% of patients having diabetes and 52% having hypertension. Among chronic diseases, coronary artery disease (CAD) was statistically significantly more common in the hormonal therapy group (17.6% vs. 4.1%, p = 0.021), while other comorbidities were observed at similar frequencies in both groups. The median Charlson comorbidity score was 5 in both groups. While relapse was observed in 8.3% of cases during follow-up, there was no significant difference between the two groups (9.3% vs. 6.1%, p = 0.756b). A total of 32 patients died, 28% in the hormonal therapy group (n = 30) and 4.2% in the chemotherapy group (n = 2) (p = 0.001). (Table-1 ) Table-1 Pathologic and Clinical features Total n = 157 Chemoterapy n = 49 Hormonal therapy n = 108 p Age, Median (IQR) 80,0 (10,0) 73,0 (12,0) 82,0 (11,8) < 0.001 a 65–70 13 (8,3) 13 (26,5) 0 (0,0) < 0.001 b ≥ 70 144 (91,7) 36 (73,5) 108 (100,0) Stage, n(%) 1A 84 (53,5) 18 (36,7) 66 (61,1) 0.004 b 2A 62 (39,5) 29 (59,2) 33 (30,6) 2B 6 (3,8) 2 (4,1) 4 (3,7) 3B 5 (3,2) 0 (0) 5 (4,6) Tumor size ( median) (IQR) 2,0 (1,3) 2,5 (1,4) 1,9 (1,0) 0.001 a Grade, n(%) 1 25 (18,0) 8 (17) 17 (18,5) 0.150 c 2 100 (71,9) 31 (66) 69 (75) 3 14 (10,1) 8 (17) 6 (6,5) E kadherin, n(%) Negative 14 (21,5) 5 (21,7) 9 (21,4) 1.000 b Positive 51 (78,5) 18 (78,3) 33 (78,6) Histology, n(%) İnvazive ductal carsinoma 57 (36,3) 18 (36,7) 39 (36,1) 0.885 c invasive lobuler carcinoma 19 (12,1) 5 (10,2) 14 (13) other 81 (51,6) 26 (53,1) 55 (50,9) Ki67, n(%) <%20 79 (61,2) 24 (54,5) 55 (64,7) 0.261 c ≥ %20 50 (31,8) 20 (45,5) 30 (35,3) Tumor localization, n(%) upper outer quadrant 66 (42,0) 19 (38,8) 47 (43,5) 0.378 b upper inner quadrant 44 (28,0) 11 (22,4) 33 (30,6) lower outer quadrant 32 (20,4) 14 (28,6) 18 (16,7) lower inner quadrant 13 (8,3) 5 (10,2) 8 (7,4) Retroareolar 2 (1,3) 0 (0) 2 (1,9) Multicenter, n(%) No 141 (89,8) 43 (87,8) 98 (90,7) 0.577 b Yes 16 (10,2) 6 (12,2) 10 (9,3) Surgery, n(%) BCS 55 (37,9) 18 (37,5) 37 (38,1) 0.940 c MRM 90 (62,1) 30 (62,5) 60 (61,9) RT, n(%) No 107 (68,2) 25 (51) 82 (75,9) 0.002 c Yes 50 (31,8) 24 (49) 26 (24,1) Charlson scor (IQR) 5,0 (2,0) 5,0 (2,0) 0.980 a DM, n(%) No 98 (62,4) 31 (63,3) 67 (62) 0.883 c Yes 59 (37,6) 18 (36,7) 41 (38) HT, n(%) No 75 (47,8) 23 (46,9) 52 (48,1) 0.888 c Yes 82 (52,2) 26 (53,1) 56 (51,9) SVO, n(%) No 155 (98,7) 48 (98) 107 (99,1) 0.528 b Yes 2 (1,3) 1 (2) 1 (0,9) CAD, n(%) No 136 (86,6) 47 (95,9) 89 (82,4) 0.021 c Yes 21 (13,4) 2 (4,1) 19 (17,6) HPL, n(%) No 152 (96,8) 48 (98) 104 (96,3) 1.000 b Yes 5 (3,2) 1 (2) 4 (3,7) COPD, n(%) No 141 (89,8) 41 (83,7) 100 (92,6) 0.096 b Yes 16 (10,2) 8 (16,3) 8 (7,4) Hormonal therapy, n(%) Anastrazol 107 (70,4) 28 (63,6) 79 (73,1) 0.105 b Letrozol 40 (26,3) 15 (34,1) 25 (23,1) Exemestan 1 (0,7) 1 (2,3) 0 (0) Tamoxifen 4 (2,6) 0 (0) 4 (3,7) Relaps, n(%) No 144 (91,7) 46 (93,9) 98 (90,7) 0.756 b Yes 13 (8,3) 3 (6,1) 10 (9,3) Mortality, n(%) Alive 123 (79,4) 46 (95,8) 77 (72) 0.001 c Dead 32 (20,6) 2 (4,2) 30 (28) Chemoterapy CA 14 (29,2) weekly paclitaxel 3 (6,3) TC 15 (31,3) CA + taxan 8 (16,7) EC 4 (8,3) CEF + taxan 3 (6,3) Carboplatin + taxan 1 (2,1) As shown in Table 2 , median OS(overall survival) was 172.3 months (95% CI:-), with a 2-year survival rate of 92.7% and a 5-year survival rate of 80.1%. The difference in median OS between treatment groups was statistically significant (p = 0.003). In the chemotherapy group, median survival was not reached, but in the hormonal therapy group, median survival was 172 months (95% CI: 81.87-262.72). Table 2 OS and RFS comparisons of the patients Overall Survival (months) Median (%95 CI) p Overall 172,30 (-) Treatment Chemotherapy - (-) 0.003 Hormonal therapy 172,30 (81,87–262,72) RFS (months) Median (%95 CI) p Overall - (-) Treatment Chemotherapy - (-) 0.782 Hormonal therapy - (-) Kaplan Meier curve, Long rank test, p < 0.05 statistically significant The overall median RFS(relapse-free survival) was not reached. The 2-year RFS rate was 98% and the 5-year RFS rate was 90%. The median RFS according to treatment group was not statistically significant (p = 0.782). For patients who received chemotherapy, the 2-year and 5-year RFS rates were 95.6% and 95.6%, respectively. In patients receiving hormonal therapy, the 2-year and 5-year RFS rate was 99.1% and 88.3% respectively. Table 3 Univariate Cox regression results for various clinical variables OS Univariate HR (95%CI) p Age (Ref:65–70) Stage (Ref:1A) 0.007 2A 1.31 (0.61-2,79) 0.482 2B 2.08 (0.27–15.97) 0.481 3B 9.52 (2.64–34.28) 0.001 Tumor size 1.29 (1.04–1.59) 0.018 Grade (Ref:1) 0.240 2 0.67 (0.27–1.67) 0.398 3 1.63 (0.46–5.71) 0.445 E kadherin (Ref:negatif) 0.50 (0.12–2.02) 0.334 Histology (ref:others) 0.774 invazive ductal carsinoma 0.77 (0.35–1.68) 0.515 invazive lobuler carsinoma 1.05 (0.34–3.17) 0.931 Ki67 (Ref: <%20 ) 1.57 (0.66–3.72) 0.297 Multicenter (Ref:no) 2.70 (1.01–7.20) 0.047 Surgery (Ref:BCS) 0.87 (0.39–1.93) 0.744 RT (Ref:No) 0.50 (0.20–1.22) 0.130 Charlson score 1.4 (0.90–1.70) 0.182 p < 0.001, -2 loglikelihood = 260.45 Table 4 Multivariate Cox regression results for various clinical variables OS Multivariate HR (95%CI) p Age (Ref:65–70) Stage (Ref:1A) 0.035 2A 0.85 (0.32-2,12) 0.744 2B 0.36 (0.01–7.45) 0.509 3B 5.27 (0.92–30.07) 0.061 Tumor size 1.35 (0.91–2.01) 0.130 Multicenter(Ref:no) 2.99 (1.10–8.09) 0.031 As shown in Table 3 , in the univariate analyses, stage, tumour size and multicenterty were found to be statistically significant with risk of death (p < 0.05). As seen in Table 4 , multivariate analyses multicenterty increased the risk of death (OR: 2.99; 95% CI: 1.10–8.09, p = 0.031) (p < 0.001) Table 5 Univariete Analysis of clinical variables for relapse-free survival RFS Univariate HR (95%CI) p Age (Ref:65–70) Stage (Ref:1A) 0.306 2A 1.82 (0.55-5,97) 0.322 2B 4.67 (0.53–40.60) 0.162 3B 4.20 (0.48–36.35) 0.192 Tumor size 1.21 (0.91–1.62) 0.178 Grade (Ref:1) 0.055 2 0.29 (0.06–1.33) 0.114 3 2.04 (0.41–10.23) 0.382 E kadherin (Ref:negatif) 29.18 (0.00-) 0.649 Histology (ref:others) 0.739 invazive ductal carsinoma 1.54 (0.51–4.66) 0.437 invazive lobuler carsinoma - (-) 0.981 Ki67 (Ref: <%20 ) 2.81 (0.79–10.01) 0.109 Multicenter (Ref:no) 0.82 (0.11–6.36) 0.855 Surgery (Ref:MKC) 0.80 (0.22–2.85) 0.735 RT (Ref:no) 0.68 (0.18–2.47) 0.559 Charlson score 1.63 (0.97–2.73) 0.064 As shown in Table 5 , univariate analysis of clinical variables did not show statistically significant results for relapse-free survival (p > 0.05). Discussion Currently, the incidence of breast cancer is increasing with age. Unfortunately, it is known that survival is lower in elderly patients due to age-related comorbidities, debility and other factors that increase mortality. In this study, we aimed to evaluate the impact of clinicopathological factors and treatment choices on survival in elderly patients with early-stage, hormone receptor-positive, HER2-negative breast cancer. Our study showed a preference for hormonal therapy over chemotherapy in the adjuvant setting in the elderly age group. Consistent with the literature, factors such as smaller tumour size, earlier stage, lower grade and lower proliferation index play a role in the decision to avoid chemotherapy in older patients [ 2 , 3 ]. As observed in studies, the preference for chemotherapy decreases in older patients, regardless of age and stage [ 13 ]. In our study, only 31% of patients were in the chemotherapy group. Elderly breast cancer patients should receive surgery, axillary lymph node dissection (ALND) if indicated, and radiotherapy (if indicated by tumour size and stage), as well as systemic adjuvant therapy, similar to younger patients. However, the rates of breast conserving surgery (BCS) and radiotherapy are lower than in younger cases [ 11 ]. Similar to the literature, our study showed that BCS is less preferred in older patients, and MRM + AD/SLND is the most commonly chosen surgical procedure [ 11 ]. As we seen in literature, radiotherapy may not be given after breast-conserving surgery in older patients with a low risk of local recurrence. In particular, radiotherapy is unnecessary for tumours that are smaller than 2 cm, node-negative and hormone-positive in patients aged seventy years or older[ 14 , 15 ]. In our study, radiotherapy was less preferred in all patient groups, being administered in 49% of chemotherapy group and 24% of hormonal therapy group. The higher rate of MRM and early stage desease in this study may be associated with the low rate of RT. In adjuvant therapy for healthy elderly individuals, anthracycline and taxane are the most commonly preferred regimens, similar to young patients. In a study conducted in this patient group, both anthracycline-containing and anthracycline-free treatments were observed to cause heart failure at similar rates as in untreated control groups[ 16 ]. For patients unsuitable for anthracycline, docetaxel and cyclophosphamide (TC) can be administered. A randomized controlled trial conducted in breast cancer patients aged 65 and above at stages I-III showed that TC had DFS and OS advantages over AC[ 17 ]. In our study, AC and TC were the most frequently preferred regimens (29% and 31%, respectively). There was a statistically significant difference in overall survival between the treatment arms, with overall survival being lower in the hormonal therapy group compared to the chemotherapy group (172 months-NR, p = 0.003). The shorter survival in this group may be due not only to a lower preference for aggressive treatment, but also to the presence of comorbidities and lower life expectancy. It is known from the literature that 13–55% of breast cancer patients aged sixty-five years and older die of causes other than breast cancer [ 3 , 17 ]. Although the number of recurrences was higher in the hormonal therapy group, the difference was not statistically significant. Of the patients who died during follow-up, the majority were in the hormone therapy group and died from causes other than recurrence. The statistically higher prevalence of coronary artery disease in this group is a significant cause of death. In the literature, a study using SEER-Medicare data to assess the impact of a breast cancer diagnosis on life expectancy found that individuals diagnosed with breast cancer at age 67 had a lower risk of early death compared with age-matched controls without breast cancer. In this group, the most common cause of death was cardiovascular disease, while stage 3 and 4 breast cancer was more likely to be the cause of death [ 17 ]. The distribution of comorbidities did not show a significant difference between treatment groups in our study. Our study has several limitations due to its retrospective, single-center design, which introduces potential selection bias. As our country is still considered a developing nation, the use of the Oncotype Dx test is quite limited for economic reasons. Consequently, traditional risk factors (such as age, grade, tumor size, and lymph node involvement) continue to play a significant role in treatment decisions. In conclusion, our study found that stage, tumor size, and multifocality were statistically significant in relation to the risk of death, but no clinicopathological factors were associated with the development of recurrence. Declarations Acknowledgments Conflict of interest statement: Researchers declare that they have no conflict of interest. Ethics approval and consent to participate: Antalya Training and Research Hospital, clinic ethics committee approval was received. No:10/20, Date:20/07/2023 Funding : None Author Contributions: EU; Data curation, and ınvestigation, writing–original draft. DK: Supervision, writing–review & editing Availability of data : The data that support the findings of this study are available from the corresponding author upon reasonable request References Louwman WJ, Vulto JCM, Verhoeven RHA, Nieuwenhuijzen GAP, Coebergh JWW, Voogd AC. Clinical epidemiology of breast cancer in the elderly. Eur J Cancer 2007;43:2242-2252. Molino A, Giovannini M, Auriemma A, Fiorio E, Mercanti A, Mandarà M, et al. Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer. Crit Rev Oncol Hematol. 2006 Sep;59(3):226-33. Schaefer G, Rosen PP, Lesser ML, Kine DW, Beatie EJ. Breast carcinoma in elderly women: pathology, prognosis and survival. Pathol Ann 1984;19:195-218. Wyld L, Reed M. The role of surgery in the management of older women with breast cancer. Eur J Cancer 2007;43:2253- 2263. Siegelmann-Danieli N, Khandelwal V, Wood GC, Mainali R, Prichard J, Murphy TJ, et al. Breast cancer in elderly women: outcome as affected by age, tumor features, comorbidities, and treatment approach. Clin Breast Cancer. 2006 Apr;7(1):59-66. Bergman L, Dekker G, van Leeuwen FE, Huisman SJ, Van Dam FS, Van Dongen JA: The effect of age on treatment choice and survival in elderly breast cancer patients. Cancer 1991;67:2227- 2234. J. L. Patnaik, T. Byers, C. Diguiseppi, T. D. Denberg, and D. Dabelea, “The influence of comorbidities on overall survival among older women diagnosed with breast cancer,” Journal of the National Cancer Institute, vol. 103, no. 14, pp. 1101–1111, 2011. Satariano W A. Ragland DR: The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994; 120(2):104-110. Fennessey M, Bates T, McRae K, Riley D, Houghton J, Baum M. Randomised trial of surgery plus tamoxifen versus tamoxifen-alone in women over age 70 with operable breast cancer. Br J Surg 2004;91:699-704. Mustacchi G, Ceccherini R, Milani S, Pluchinotta A, De Matteis A, Maiorino L,et al., Italian Cooperative Group GRETA. Tamoxifen alone versus adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trial. Ann Oncol. 2003 Mar;14(3):414-20. Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013 Jul 1;31(19):2382-7. Sail KR, Franzini L, Lairson DR, Du XL. Clinical and economic outcomes associated with adjuvant chemotherapy in elderly patients with early stage operable breast cancer. Value Health. 2012 Jan;15(1):72-80. doi: 10.1016/j.jval.2011.10.004. PMID: 22264974. Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010 Dec;124(3):801-7. Smith BD, Gross CP, Smith GL, Galusha DH, Bekelman JE, Haffty BG. Effectiveness of radiation therapy for older women with early breast cancer. J Natl Cancer Inst. 2006 May 17;98(10):681-90. Ali AA, Tawk R, Xiao H, Semykina A, Montero AJ, Moussa RK, et al. Comparative cost-effectiveness of radiotherapy among older women with hormone receptor positive early-stage breast cancer. Expert Rev Pharmacoecon Outcomes Res. 2022 Jul;22(5):735-741. M. C. Pinder, Z. Duan, J. S. Goodwin, G. N. Hortobagyi, and S. H. Giordano, “Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer,” Journal of Clinical Oncology, vol. 25, no. 25, pp. 3808–3815, 2007. C. M. A. Schonberg, E. R. Marcantonio, L. Ngo, D. Li, R. A. Silliman, and E. P. McCarthy, “Causes of death and relative survival of older women after a breast cancer diagnosis,” Journal of Clinical Oncology, vol. 29, no. 12, pp. 1570–1577, 2011. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5633887","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":398184671,"identity":"5056065d-9700-4723-a0b5-ae4f9a581905","order_by":0,"name":"Esma Uguztemur","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYPCDigNg6sADYhTzgMkzB8CMAwlEa2Fsg2hhwKeFn/904meeX4ft7dm706Qr592Rsxc7/BBoi52cbgN2LZIzcjdL8/YdZubhObtN8uy2Z8Y80mkGQC3JxmYHsGsxuMG7QZq35zAbj0TuNsnGbYcTe6QTQFoOJG7DocX+/NnNv4FaeHjk3wK1zAFpSf+AV4sBQ+42aZ4fhyV4JHiBWhpAWnLw2yJxI3eb5dyGdAOeM7mbLRuOHTbmuZ1TcCDBALdf+PvPbr7x5o+1PXv72Y03G2oOy7HPTt/84UOFnRwuLWDA2IbFwQTAH0IKRsEoGAWjYEQDAJ4iYpBpZr5zAAAAAElFTkSuQmCC","orcid":"","institution":"Antalya Training and Research Hospital Medical Oncology Department","correspondingAuthor":true,"prefix":"","firstName":"Esma","middleName":"","lastName":"Uguztemur","suffix":""},{"id":398184672,"identity":"1dc2b1ca-e72b-4d19-972d-5d5bf3e394ce","order_by":1,"name":"Derya Kivrak Salim","email":"","orcid":"","institution":"Antalya Training and Research Hospital Medical Oncology Department","correspondingAuthor":false,"prefix":"","firstName":"Derya","middleName":"Kivrak","lastName":"Salim","suffix":""}],"badges":[],"createdAt":"2024-12-12 19:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5633887/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5633887/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76408785,"identity":"0a893227-10e2-4618-824a-49d57cfb92ee","added_by":"auto","created_at":"2025-02-16 23:01:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1134218,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5633887/v1/d8825690-c36f-405c-8392-d8d12e154e6e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of treatment preferences on survival in early stage breast cancer in elderly patients over 65 years of age","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer incidence and mortality increase with age, making it a major public health concern, particularly in countries with ageing populations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, older patients are often underrepresented in breast cancer treatment trials. It has been observed that breast cancer in this age group tends to be less aggressive, with higher hormone expression, lower grade 3 tumour incidence, lower proliferation markers, etc. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. On the other hand, the higher prevalence of comorbidities in older women, reduced physical and functional capacity, increases the morbidity associated with both the disease and its treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTreatment decisions are influenced by age, with less aggressive treatments chosen for older patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Factors such as life expectancy and the presence of comorbidities, in addition to the less aggressive nature of breast cancer in the elderly, play a role in this decision-making process.\u003c/p\u003e \u003cp\u003eThe presence of comorbidities has a direct impact on survival, regardless of age and tumour stage[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Among breast cancer patients aged sixty-five years and older, 13\u0026ndash;55% die from causes other than breast cancer [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe standard treatment is surgery for older breast cancer patients who are physically fit and suitable for surgery. Healthy older women tolerate the standard treatment as well as younger patients. Hormone therapy alone may be an option for patients who are ineligible for surgery, but these patients have been shown to have more regional recurrences, requiring more frequent surgery later in life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile standard treatment approaches should be applied similarly to young patients, the rates of breast conserving surgery (BCS) and radiotherapy are lower than in younger cases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Radiotherapy may not be given after breast-conserving surgery in older patients with a low risk of local recurrence.\u003c/p\u003e \u003cp\u003eThe rate of adjuvant chemotherapy is also lower in elderly breast cancer patients, regardless of tumour size. Sail KR et al reported a significant decrease in the use of chemotherapy with increasing age for different stages. In stage III breast cancer, 49% of patients aged 65\u0026ndash;69 years received chemotherapy, whereas this rate decreased to 10% in patients aged 80 years and older[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eElderly breast cancer cases, despite constituting the majority of breast cancer cases, are not included in prospective randomized trials, and information about their treatment is based on retrospective study results and observations. In this study, we aimed to retrospectively evaluate the clinical and pathological characteristics and treatment approaches impact on survival in elderly early-stage breast cancer patients with hormone receptor-positive and HER2-negative tumors.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eBetween 2003 and 2022, patients aged 65 years and older, diagnosed with early-stage hormone receptor-positive, HER2-negative breast cancer, and no lymph node involvement, who applied to the Medical Oncology Department of Antalya Training and Research Hospital, were retrospectively evaluated. Since chemotherapy would be prioritized for node-positive patients, this group was excluded from the study. Our aim was to evaluate adjuvant treatment preferences, so we also excluded patients who received neoadjuvant therapy. A total of 157 patients were included in the study.\u003c/p\u003e \u003cp\u003eThe patients were divided into two groups: those who received chemotherapy after surgery and those who received hormonal therapy after surgery. The chemotherapy group also received hormonal therapy following chemotherapy.\u003c/p\u003e \u003cp\u003eThe pathological and clinical findings were compared, including tumor size, disease stage, tumor location, multifocality, surgical method, radiotherapy, and the Charlson comorbidity score. Factors affecting relapse-free survival (RFS) and overall survival (OS) were also assessed.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using \"IBM SPSS Statistics for Windows, Version 25.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA).\" Descriptive statistics were presented as n and % for categorical variables and median (IQR) for continuous variables. Mann-Whitney U test was used for the comparison of age, tumor size, and Charlson comorbidity score between treatment groups. Pearson Chi-Square test and Fisher\u0026rsquo;s Exact test were used for the comparison of categorical variables. Kaplan-Meier method was used to compare survival and RFS times between treatment groups among various clinical parameter groups. Lastly, Univariate and Multivariate Cox Regression results were provided for various clinical factors' impact on the risk of death and RFS. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 157 patients were included in the study, excluding patients who received neoadjuvant treatment. After surgery, 108 patients in the hormonal therapy group and 49 patients in the chemotherapy group were compared. The mean age was statistically significantly older in the hormonal therapy group (82 vs 73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The tumour size was larger in the chemotherapy group and this difference was statistically significant (mean 2.5 cm vs. 1.9 cm, respectively, p\u0026thinsp;=\u0026thinsp;0.001). While 61.1% of patients in the hormonal therapy group were Stage 1A, 59% of patients in the chemotherapy group were Stage 2A. Chemotherapy was more preferred in advanced-stage diseases, and this was statistically significant (p\u0026thinsp;=\u0026thinsp;0.004). There was no significant difference between the two groups with regard to grade, histological subtype, ki-67 ratio, E-cadherin, tumour location, multifocality and surgical method. In 71.9% of patients, the tumour was grade 2 and 61% had a ki-67 ratio of less than 20%. Less aggressive tumours were observed in patients aged 65 years and older. While mastectomy with axillary lymph node dissection (MRM\u0026thinsp;+\u0026thinsp;AD/SLND) was preferred in 62.1% of patients, breast conserving surgery\u003c/p\u003e \u003cp\u003ewith sentinel lymph node dissection (BCS\u0026thinsp;+\u0026thinsp;SLND) was chosen in 37.9% of patients. BCS was not preferred in patients aged 65 years and older. Radiotherapy was given in 49% of patients who received chemotherapy compared to 24.1% of patients who received hormonal therapy, and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.002). This may be related to the higher rate of MRM and lower stage in this group. The most commonly used treatments in the chemotherapy group were adriamycin\u0026thinsp;+\u0026thinsp;cyclophosphamide (AC) and docetaxel\u0026thinsp;+\u0026thinsp;cyclophosphamide (TC).\u003c/p\u003e \u003cp\u003eThe most common comorbidities in both groups were diabetes mellitus and hypertension, with 37.6% of patients having diabetes and 52% having hypertension. Among chronic diseases, coronary artery disease (CAD) was statistically significantly more common in the hormonal therapy group (17.6% vs. 4.1%, p\u0026thinsp;=\u0026thinsp;0.021), while other comorbidities were observed at similar frequencies in both groups. The median Charlson comorbidity score was 5 in both groups. While relapse was observed in 8.3% of cases during follow-up, there was no significant difference between the two groups (9.3% vs. 6.1%, p\u0026thinsp;=\u0026thinsp;0.756b). A total of 32 patients died, 28% in the hormonal therapy group (n\u0026thinsp;=\u0026thinsp;30) and 4.2% in the chemotherapy group (n\u0026thinsp;=\u0026thinsp;2) (p\u0026thinsp;=\u0026thinsp;0.001). (Table-1 )\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable-1 Pathologic and Clinical features\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;157\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChemoterapy\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;49\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHormonal therapy\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;108\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, Median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80,0 (10,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73,0 (12,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82,0 (11,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (26,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (91,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (73,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (100,0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (53,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (61,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (39,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (59,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (30,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (4,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumor size\u003c/b\u003e (\u003cb\u003emedian) (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,0 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,5 (1,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,9 (1,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (18,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (18,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.150\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (71,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (10,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (6,5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eE kadherin, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (21,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (21,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (21,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (78,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (78,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (78,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistology, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eİnvazive ductal carsinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (36,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (36,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.885\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einvasive lobuler carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (12,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (51,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (53,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (50,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKi67, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;%20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (61,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (54,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (64,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.261\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; %20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (31,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (45,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (35,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumor localization, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eupper outer quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (42,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (38,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (43,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.378\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eupper inner quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (28,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (22,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (30,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elower outer quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (20,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (28,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (16,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elower inner quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (7,4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetroareolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulticenter, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (89,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (87,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (90,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.577\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (10,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (12,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (9,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (37,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (37,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (38,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.940\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (62,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (62,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (61,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRT, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (68,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (75,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (31,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (24,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson scor (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,0 (2,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,0 (2,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.980\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (62,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (63,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.883\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (37,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHT, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (47,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (46,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (48,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.888\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (52,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (53,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (51,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSVO, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (98,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (99,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.528\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCAD, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (86,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (95,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (82,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (13,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (17,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHPL, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152 (96,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (96,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOPD, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (89,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (83,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (92,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.096\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (10,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (16,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (7,4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHormonal therapy, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastrazol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (70,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (63,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (73,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.105\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLetrozol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (26,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (34,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (23,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExemestan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTamoxifen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelaps, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (91,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (93,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (90,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.756\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (9,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMortality, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123 (79,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (95,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (20,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemoterapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (29,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweekly paclitaxel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (31,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA\u0026thinsp;+\u0026thinsp;taxan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEF\u0026thinsp;+\u0026thinsp;taxan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarboplatin\u0026thinsp;+\u0026thinsp;taxan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e, median OS(overall survival) was 172.3 months (95% CI:-), with a 2-year survival rate of 92.7% and a 5-year survival rate of 80.1%. The difference in median OS between treatment groups was statistically significant (p\u0026thinsp;=\u0026thinsp;0.003). In the chemotherapy group, median survival was not reached, but in the hormonal therapy group, median survival was 172 months (95% CI: 81.87-262.72).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOS and RFS comparisons of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Survival (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172,30 (-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- (-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHormonal therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172,30 (81,87\u0026ndash;262,72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRFS (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (%95 CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- (-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- (-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHormonal therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- (-)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eKaplan Meier curve, Long rank test, p \u003c 0.05 statistically significant\u003c/h3\u003e\n\u003cp\u003eThe overall median RFS(relapse-free survival) was not reached. The 2-year RFS rate was 98% and the 5-year RFS rate was 90%. The median RFS according to treatment group was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.782). For patients who received chemotherapy, the 2-year and 5-year RFS rates were 95.6% and 95.6%, respectively. In patients receiving hormonal therapy, the 2-year and 5-year RFS rate was 99.1% and 88.3% respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Cox regression results for various clinical variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (Ref:65\u0026ndash;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage (Ref:1A)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.31 (0.61-2,79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.08 (0.27\u0026ndash;15.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.52 (2.64\u0026ndash;34.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumor size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.29 (1.04\u0026ndash;1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade (Ref:1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67 (0.27\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.63 (0.46\u0026ndash;5.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eE kadherin (Ref:negatif)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50 (0.12\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistology (ref:others)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003einvazive ductal carsinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77 (0.35\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003einvazive lobuler carsinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.05 (0.34\u0026ndash;3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKi67 (Ref: \u0026lt;%20 )\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.57 (0.66\u0026ndash;3.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulticenter (Ref:no)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.70 (1.01\u0026ndash;7.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery (Ref:BCS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87 (0.39\u0026ndash;1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRT (Ref:No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50 (0.20\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4 (0.90\u0026ndash;1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001, -2 loglikelihood\u0026thinsp;=\u0026thinsp;260.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Cox regression results for various clinical variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Ref:65\u0026ndash;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage (Ref:1A)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.32-2,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.36 (0.01\u0026ndash;7.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.27 (0.92\u0026ndash;30.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumor size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35 (0.91\u0026ndash;2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulticenter(Ref:no)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.99 (1.10\u0026ndash;8.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, in the univariate analyses, stage, tumour size and multicenterty were found to be statistically significant with risk of death (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As seen in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e, multivariate analyses multicenterty increased the risk of death (OR: 2.99; 95% CI: 1.10\u0026ndash;8.09, p\u0026thinsp;=\u0026thinsp;0.031) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariete Analysis of clinical variables for relapse-free survival\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRFS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (Ref:65\u0026ndash;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage (Ref:1A)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.82 (0.55-5,97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.67 (0.53\u0026ndash;40.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.20 (0.48\u0026ndash;36.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumor size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21 (0.91\u0026ndash;1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade (Ref:1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.29 (0.06\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.04 (0.41\u0026ndash;10.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eE kadherin (Ref:negatif)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.18 (0.00-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistology (ref:others)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003einvazive ductal carsinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.54 (0.51\u0026ndash;4.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003einvazive lobuler carsinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- (-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKi67 (Ref: \u0026lt;%20 )\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.81 (0.79\u0026ndash;10.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulticenter (Ref:no)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82 (0.11\u0026ndash;6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery (Ref:MKC)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80 (0.22\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRT (Ref:no)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68 (0.18\u0026ndash;2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.63 (0.97\u0026ndash;2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e, univariate analysis of clinical variables did not show statistically significant results for relapse-free survival (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, the incidence of breast cancer is increasing with age. Unfortunately, it is known that survival is lower in elderly patients due to age-related comorbidities, debility and other factors that increase mortality. In this study, we aimed to evaluate the impact of clinicopathological factors and treatment choices on survival in elderly patients with early-stage, hormone receptor-positive, HER2-negative breast cancer. Our study showed a preference for hormonal therapy over chemotherapy in the adjuvant setting in the elderly age group. Consistent with the literature, factors such as smaller tumour size, earlier stage, lower grade and lower proliferation index play a role in the decision to avoid chemotherapy in older patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As observed in studies, the preference for chemotherapy decreases in older patients, regardless of age and stage [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our study, only 31% of patients were in the chemotherapy group.\u003c/p\u003e \u003cp\u003eElderly breast cancer patients should receive surgery, axillary lymph node dissection (ALND) if indicated, and radiotherapy (if indicated by tumour size and stage), as well as systemic adjuvant therapy, similar to younger patients. However, the rates of breast conserving surgery (BCS) and radiotherapy are lower than in younger cases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Similar to the literature, our study showed that BCS is less preferred in older patients, and MRM\u0026thinsp;+\u0026thinsp;AD/SLND is the most commonly chosen surgical procedure [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs we seen in literature, radiotherapy may not be given after breast-conserving surgery in older patients with a low risk of local recurrence. In particular, radiotherapy is unnecessary for tumours that are smaller than 2 cm, node-negative and hormone-positive in patients aged seventy years or older[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In our study, radiotherapy was less preferred in all patient groups, being administered in 49% of chemotherapy group and 24% of hormonal therapy group. The higher rate of MRM and early stage desease in this study may be associated with the low rate of RT.\u003c/p\u003e \u003cp\u003eIn adjuvant therapy for healthy elderly individuals, anthracycline and taxane are the most commonly preferred regimens, similar to young patients. In a study conducted in this patient group, both anthracycline-containing and anthracycline-free treatments were observed to cause heart failure at similar rates as in untreated control groups[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For patients unsuitable for anthracycline, docetaxel and cyclophosphamide (TC) can be administered. A randomized controlled trial conducted in breast cancer patients aged 65 and above at stages I-III showed that TC had DFS and OS advantages over AC[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our study, AC and TC were the most frequently preferred regimens (29% and 31%, respectively).\u003c/p\u003e \u003cp\u003eThere was a statistically significant difference in overall survival between the treatment arms, with overall survival being lower in the hormonal therapy group compared to the chemotherapy group (172 months-NR, p\u0026thinsp;=\u0026thinsp;0.003). The shorter survival in this group may be due not only to a lower preference for aggressive treatment, but also to the presence of comorbidities and lower life expectancy. It is known from the literature that 13\u0026ndash;55% of breast cancer patients aged sixty-five years and older die of causes other than breast cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although the number of recurrences was higher in the hormonal therapy group, the difference was not statistically significant. Of the patients who died during follow-up, the majority were in the hormone therapy group and died from causes other than recurrence. The statistically higher prevalence of coronary artery disease in this group is a significant cause of death. In the literature, a study using SEER-Medicare data to assess the impact of a breast cancer diagnosis on life expectancy found that individuals diagnosed with breast cancer at age 67 had a lower risk of early death compared with age-matched controls without breast cancer. In this group, the most common cause of death was cardiovascular disease, while stage 3 and 4 breast cancer was more likely to be the cause of death [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The distribution of comorbidities did not show a significant difference between treatment groups in our study.\u003c/p\u003e \u003cp\u003eOur study has several limitations due to its retrospective, single-center design, which introduces potential selection bias. As our country is still considered a developing nation, the use of the Oncotype Dx test is quite limited for economic reasons. Consequently, traditional risk factors (such as age, grade, tumor size, and lymph node involvement) continue to play a significant role in treatment decisions. In conclusion, our study found that stage, tumor size, and multifocality were statistically significant in relation to the risk of death, but no clinicopathological factors were associated with the development of recurrence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u0026nbsp;\u003c/strong\u003eResearchers declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;Antalya Training and Research Hospital, clinic ethics committee approval was received. No:10/20, Date:20/07/2023\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEU; Data curation, \u0026nbsp;and ınvestigation, writing\u0026ndash;original draft. DK: Supervision, writing\u0026ndash;review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e : The data that support the findings of this study are available from the corresponding author upon reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLouwman WJ, Vulto JCM, Verhoeven RHA, Nieuwenhuijzen GAP, Coebergh JWW, Voogd AC. Clinical epidemiology of breast cancer in the elderly. Eur J Cancer 2007;43:2242-2252.\u003c/li\u003e\n\u003cli\u003eMolino A, Giovannini M, Auriemma A, Fiorio E, Mercanti A, Mandar\u0026agrave; M, et al. Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer. Crit Rev Oncol Hematol. 2006 Sep;59(3):226-33. \u003c/li\u003e\n\u003cli\u003eSchaefer G, Rosen PP, Lesser ML, Kine DW, Beatie EJ. Breast carcinoma in elderly women: pathology, prognosis and survival. Pathol Ann 1984;19:195-218.\u003c/li\u003e\n\u003cli\u003eWyld L, Reed M. The role of surgery in the management of older women with breast cancer. Eur J Cancer 2007;43:2253- 2263.\u003c/li\u003e\n\u003cli\u003eSiegelmann-Danieli N, Khandelwal V, Wood GC, Mainali R, Prichard J, Murphy TJ, et al. Breast cancer in elderly women: outcome as affected by age, tumor features, comorbidities, and treatment approach. Clin Breast Cancer. 2006 Apr;7(1):59-66.\u003c/li\u003e\n\u003cli\u003eBergman L, Dekker G, van Leeuwen FE, Huisman SJ, Van Dam FS, Van Dongen JA: The effect of age on treatment choice and survival in elderly breast cancer patients. Cancer 1991;67:2227- 2234.\u003c/li\u003e\n\u003cli\u003eJ. L. Patnaik, T. Byers, C. Diguiseppi, T. D. Denberg, and D. Dabelea, \u0026ldquo;The influence of comorbidities on overall survival among older women diagnosed with breast cancer,\u0026rdquo; Journal of the National Cancer Institute, vol. 103, no. 14, pp. 1101\u0026ndash;1111, 2011.\u003c/li\u003e\n\u003cli\u003eSatariano W A. Ragland DR: The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994; 120(2):104-110.\u003c/li\u003e\n\u003cli\u003eFennessey M, Bates T, McRae K, Riley D, Houghton J, Baum M. Randomised trial of surgery plus tamoxifen versus tamoxifen-alone in women over age 70 with operable breast cancer. Br J Surg 2004;91:699-704.\u003c/li\u003e\n\u003cli\u003eMustacchi G, Ceccherini R, Milani S, Pluchinotta A, De Matteis A, Maiorino L,et al., Italian Cooperative Group GRETA. Tamoxifen alone versus adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trial. Ann Oncol. 2003 Mar;14(3):414-20. \u003c/li\u003e\n\u003cli\u003eHughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013 Jul 1;31(19):2382-7.\u003c/li\u003e\n\u003cli\u003eSail KR, Franzini L, Lairson DR, Du XL. Clinical and economic outcomes associated with adjuvant chemotherapy in elderly patients with early stage operable breast cancer. Value Health. 2012 Jan;15(1):72-80. doi: 10.1016/j.jval.2011.10.004. PMID: 22264974.\u003c/li\u003e\n\u003cli\u003eBastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010 Dec;124(3):801-7.\u003c/li\u003e\n\u003cli\u003eSmith BD, Gross CP, Smith GL, Galusha DH, Bekelman JE, Haffty BG. Effectiveness of radiation therapy for older women with early breast cancer. J Natl Cancer Inst. 2006 May 17;98(10):681-90.\u003c/li\u003e\n\u003cli\u003eAli AA, Tawk R, Xiao H, Semykina A, Montero AJ, Moussa RK, et al. Comparative cost-effectiveness of radiotherapy among older women with hormone receptor positive early-stage breast cancer. Expert Rev Pharmacoecon Outcomes Res. 2022 Jul;22(5):735-741.\u003c/li\u003e\n\u003cli\u003eM. C. Pinder, Z. Duan, J. S. Goodwin, G. N. Hortobagyi, and S. H. Giordano, \u0026ldquo;Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer,\u0026rdquo; Journal of Clinical Oncology, vol. 25, no. 25, pp. 3808\u0026ndash;3815, 2007.\u003c/li\u003e\n\u003cli\u003eC. M. A. Schonberg, E. R. Marcantonio, L. Ngo, D. Li, R. A. Silliman, and E. P. McCarthy, \u0026ldquo;Causes of death and relative survival of older women after a breast cancer diagnosis,\u0026rdquo; Journal of Clinical Oncology, vol. 29, no. 12, pp. 1570\u0026ndash;1577, 2011.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, elderly, hormonal treatment, comorbidity","lastPublishedDoi":"10.21203/rs.3.rs-5633887/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5633887/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe increasing incidence and mortality of breast cancer with age remains a major health concern, particularly in the elderly population. However, the under-representation of older patients in clinical trials complicates our understanding of the characteristics of this population. In this retrospective study, we evaluated breast cancer patients aged 65 years and older with early-stage hormone receptor-positive, HER2-negative disease.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA total of 157 patients were included in the study. We compared groups who received postoperative chemotherapy or hormonal therapy, and evaluated several clinical and pathological factors.Factors affecting relapse-free survival (RFS) and overall survival (OS) were evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur results showed a lower overall survival in the hormone therapy group compared to the chemotherapy group. However, this difference suggested the influence of not only the preference for non-aggressive treatments, but also the effect of comorbidities and life expectancy. Analysis of the causes of death showed that coronary heart disease was prominent in the hormone therapy group, suggesting that most deaths were due to causes other than breast cancer recurrence.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur results highlight the importance of considering overall health and life expectancy when deciding on treatment options for advanced breast cancer patients. In addition, findings suggesting that aggressive treatments in older patients may provide limited benefit and reduce quality of life emphasise the need for more personalised treatment strategies in this population.\u003c/p\u003e","manuscriptTitle":"The effect of treatment preferences on survival in early stage breast cancer in elderly patients over 65 years of age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-08 06:31:36","doi":"10.21203/rs.3.rs-5633887/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"218afe0a-de3a-40a7-bfee-4337d9228c44","owner":[],"postedDate":"January 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-16T22:53:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-08 06:31:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5633887","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5633887","identity":"rs-5633887","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}