Mortality in Older Patients with Breast Cancer Undergoing Breast Surgery: How Low is Low Risk?

Background Breast surgery carries a low risk of postoperative mortality. For older patients with multiple comorbidities, even low-risk procedures can confer some increased perioperative risk. We sought to identify factors associated with postoperative mortality in breast cancer patients >= 70 years to create a nomogram for predicting risk of death within 90 days. Methods Patients diagnosed with nonmetastatic invasive breast cancer (2010-2016) were selected from the National Cancer Database. Unadjusted OS was estimated using the Kaplan-Meier method. Multivariate logistic regression was used to estimate the association of age and surgery with 90-day mortality and to build a predictive nomogram. Results Among surgical patients >= 70 years, unadjusted 90-day mortality increased with increasing age (70-74 = 0.4% vs. >= 85 = 1.6%), comorbidity score (0 = 0.5% vs. >= 3 = 2.7%), and disease stage (I = 0.4% vs. III = 2.7%; all p < 0.001). After adjustment, death within 90 days of surgery was associated with higher age (>= 85 vs. 70-74: odds ratio [OR] 3.16, 95% confidence interval [CI] 2.74-3.65), comorbidity score (>= 3 vs. 0: OR 4.79, 95% CI 3.89-5.89), and disease stage (III vs. I: OR 4.30, 95% CI 3.69-5.00). Based on these findings, seven variables (age, gender, comorbidity score, facility type, facility location, clinical stage, and surgery type) were selected to build a nomogram; estimates of risk of death within 90 days ranged from 30%. Conclusions Breast operations remain relatively low-risk procedures for older patients with breast cancer, but select factors can be used to estimate the risk of postoperative mortality to guide surgical decision-making among older women.

Automated summary

The study found that factors such as age, comorbidity score, and disease stage were associated with increased postoperative mortality risk in breast cancer patients aged 70 and older. By creating a predictive nomogram, the risk of death within 90 days post-surgery can be estimated, aiding in surgical decision-making for older women with breast cancer.