Prognostic Factors and Survival in Elderly Breast Cancer Patients: Roles of Age, Stage and Inflammatory Markers

Introduction: In elderly individuals, breast cancer is a major clinical problem, and sufficient data regarding treatment in this population are lacking. This study aimed to investigate the clinical and pathological characteristics and overall survival of elderly patients with breast cancer, as well as the factors influencing survival outcomes . Methods: This retrospective study included 261 patients aged 65 years or older who were diagnosed with breast cancer and treated at the Medical Oncology Department of Dokuz Eylül University Faculty of Medicine between 2010 and 2023. The clinical and pathological characteristics and treatment modalities of the included patients were analyzed, as were their biochemical results, which included the NLR, LDH and NLI. The patients were stratified into three age groups (65–74, 75–84, and ≥85 years), and intergroup differences were assessed. Survival analyses were conducted via Kaplan‒Meier and log-rank tests, and multivariate analyses were performed according to the Cox regression model. The diagnostic features of the biochemical variables were verified via receiver operating characteristic (ROC) analyses. Results: A total of 261 patients were included in the study, with a median age at diagnosis of 73.5 years (range: 65–88). The median survival time in the 65–74 year age group (n=145) was 148 months (95% CI, 123.71–172.28), that in the 75–84 year age group was 91 months (95% CI, 71.10– 110.89), and that in the 85+ year age group was 58 months (95% CI, 25.73–90.26) (p<0.05). Patients aged 85 years and older were less likely to undergo surgery and receive adjuvant chemotherapy (p<0.05). No significant differences were observed among the age groups regarding pathological features or the rate of neoadjuvant therapy. However, older patients are more likely to be diagnosed at advanced stages than their younger counterparts are (p<0.05). Univariate survival analysis revealed that advanced disease stage at diagnosis and a high dNLR and estrogen receptor status have prognostic importance; however, tumor grade, progesterone receptor status and whether adjuvant or neoadjuvant therapy is administered do not significantly affect overall survival. ROC analysis revealed that the LDH value was insignificant; thus, the LDH and NLI (LDH combined with the dNLR) indices were excluded from the survival analysis. Conclusion: Although clinicopathological features were similar across age groups, elderly patients—particularly those over 85—received less aggressive curative treatment. Advanced stage, age, and elevated inflammatory markers (dNLRs) are independent predictors of mortality. These findings suggest that treatment decisions should be personalized through geriatric assessment to avoid undertreatment, as this population can achieve substantial survival.