Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2− breast cancer: a propensity score-matched retrospective cohort study using the SEER database

Objectives This study aimed to investigate the impact of adjuvant chemotherapy (ACT) on survival outcomes in older women with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer (BC). Design A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database, which contains publicly available information from US cancer registries. Setting and participants The study included 45 762 older patients with BC aged over 65 years diagnosed between 2010 and 2015. Methods Patients were divided into two groups based on age: 65–79 years and ≥80 years. Propensity score matching (PSM) was employed to balance clinicopathological characteristics between patients who received ACT and those who did not. Data analysis used the χ 2 test and Kaplan-Meier method, with a subgroup analysis conducted to identify potential beneficiaries of ACT. Outcome measures Overall survival (OS) and cancer-specific survival (CSS). Results Due to clinicopathological characteristic imbalances between patients with BC aged 65–79 years and those aged ≥80 years, PSM was used to categorise the population into two groups for analysis: the 65–79 years age group (n=38 128) and the ≥80 years age group (n=7634). Among patients aged 65–79 years, Kaplan-Meier analysis post-PSM indicated that ACT was effective in improving OS (p<0.05, HR=0.80, 95% CI 0.73 to 0.88), particularly in those with advanced disease stages, but did not show a significant benefit in CSS (p=0.09, HR=1.13, 95% CI 0.98 to 1.31). Conversely, for patients aged ≥80 years, ACT did not demonstrate any improvement in OS (p=0.79, HR=1.04, 95% CI 0.79 to 1.36) or CSS (p=0.09, HR=1.46, 95% CI 0.69 to 2.26) after matching. Subgroup analysis also revealed no positive impact on OS and CSS. Conclusions Patients with HR+/HER2− BC ≥80 years of age may be considered exempt from ACT because no benefits were found in terms of OS and CSS.