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Background <p>Breast cancer is a major clinical problem in elderly patients, yet data on prognostic factors and treatment outcomes in this population remain limited. This study investigated clinical characteristics, treatment patterns, and survival in elderly breast cancer patients, with focus on functional status, comorbidity burden, and inflammatory markers.</p> Methods <p>This retrospective study included 261 patients aged ≥ 65 years diagnosed with breast cancer at Dokuz Eylül University Medical Oncology Clinic between 2010 and 2023. Patients were stratified into two age groups (65–74 and ≥ 75 years). Clinicopathological characteristics, treatment modalities, ECOG performance status, Charlson Comorbidity Index (CCI), and the derived neutrophil-to-lymphocyte ratio (dNLR) were analyzed. Treatment comparisons were restricted to non-metastatic disease (stage I–III, <i>n</i> = 204). Survival was analyzed with Kaplan–Meier and log-rank tests. Receiver operating characteristic (ROC) analysis identified an optimal dNLR cutoff, and time-dependent ROC with inverse probability of censoring weighting assessed discriminatory performance over time. Multivariate Cox regression with backward likelihood ratio elimination identified independent prognostic factors; Harrell’s concordance index was calculated for model validation.</p> Results <p>Median follow-up was 142 months. No significant differences were observed between age groups regarding pathological features, receptor status, or comorbidities. However, patients aged ≥ 75 years were less likely to undergo primary surgery (<i>p</i> = 0.041), adjuvant chemotherapy (<i>p</i> = 0.001), or radiotherapy (<i>p</i> = 0.001). Median overall survival was 148 versus 87 months (<i>p</i> &lt; 0.001). ROC identified an optimal dNLR cutoff of 1.74 (AUC 0.628); time-dependent AUCs were 0.772, 0.652, and 0.668 at 1, 3, and 5 years. LDH showed no significant discriminatory capacity. Multivariate analysis identified ECOG ≥ 2 (HR 2.89), CCI ≥ 3 (HR 2.12), stage IV (HR 7.43), dNLR &gt; 1.74 (HR 2.14), TNBC (HR 2.30), age ≥ 75 (HR 1.52), and surgery (HR 0.53) as independent predictors of mortality. The full model achieved a C-index of 0.792.</p> Conclusion <p>Elderly breast cancer patients are less frequently treated despite similar clinicopathological features. ECOG performance status, CCI, disease stage, dNLR, and clinical subtype are independent predictors of mortality. The prognostic impact of chronological age was substantially attenuated after adjusting for functional status and comorbidity, emphasizing that treatment decisions should be guided by comprehensive geriatric assessment rather than age alone.</p>

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Prognostic factors and survival in elderly breast cancer patients: roles of age, stage and inflammatory markers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月7日

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  • Doğancan Akpalamut,
  • Halil İbrahim Ellez,
  • Elif Atağ,
  • Oktay Halit Aktepe,
  • Hüseyin Salih Semiz,
  • Aziz Karaoğlu

摘要

Background

Breast cancer is a major clinical problem in elderly patients, yet data on prognostic factors and treatment outcomes in this population remain limited. This study investigated clinical characteristics, treatment patterns, and survival in elderly breast cancer patients, with focus on functional status, comorbidity burden, and inflammatory markers.

Methods

This retrospective study included 261 patients aged ≥ 65 years diagnosed with breast cancer at Dokuz Eylül University Medical Oncology Clinic between 2010 and 2023. Patients were stratified into two age groups (65–74 and ≥ 75 years). Clinicopathological characteristics, treatment modalities, ECOG performance status, Charlson Comorbidity Index (CCI), and the derived neutrophil-to-lymphocyte ratio (dNLR) were analyzed. Treatment comparisons were restricted to non-metastatic disease (stage I–III, n = 204). Survival was analyzed with Kaplan–Meier and log-rank tests. Receiver operating characteristic (ROC) analysis identified an optimal dNLR cutoff, and time-dependent ROC with inverse probability of censoring weighting assessed discriminatory performance over time. Multivariate Cox regression with backward likelihood ratio elimination identified independent prognostic factors; Harrell’s concordance index was calculated for model validation.

Results

Median follow-up was 142 months. No significant differences were observed between age groups regarding pathological features, receptor status, or comorbidities. However, patients aged ≥ 75 years were less likely to undergo primary surgery (p = 0.041), adjuvant chemotherapy (p = 0.001), or radiotherapy (p = 0.001). Median overall survival was 148 versus 87 months (p < 0.001). ROC identified an optimal dNLR cutoff of 1.74 (AUC 0.628); time-dependent AUCs were 0.772, 0.652, and 0.668 at 1, 3, and 5 years. LDH showed no significant discriminatory capacity. Multivariate analysis identified ECOG ≥ 2 (HR 2.89), CCI ≥ 3 (HR 2.12), stage IV (HR 7.43), dNLR > 1.74 (HR 2.14), TNBC (HR 2.30), age ≥ 75 (HR 1.52), and surgery (HR 0.53) as independent predictors of mortality. The full model achieved a C-index of 0.792.

Conclusion

Elderly breast cancer patients are less frequently treated despite similar clinicopathological features. ECOG performance status, CCI, disease stage, dNLR, and clinical subtype are independent predictors of mortality. The prognostic impact of chronological age was substantially attenuated after adjusting for functional status and comorbidity, emphasizing that treatment decisions should be guided by comprehensive geriatric assessment rather than age alone.