Oncology ·
Primary Endocrine Therapy and Surgery Show Similar Survival in Older Women
A systematic review and meta-analysis included 29 studies of 22,821 women with operable, nonmetastatic, estrogen receptor–positive breast cancer. Pooled randomized-trial data found no statistically significant overall-survival difference between primary endocrine therapy and upfront surgery, while observational studies suggested that tumor biology was associated with progression risk.
- No significant overall-survival difference was detected in pooled trial data.
- The overall-survival estimate numerically favored surgery.
- Progression times varied by tumor selection and endocrine treatment era.
- Tumor biology was associated with progression risk.
Researchers reviewed six randomized clinical trials and 23 observational cohorts comparing primary endocrine therapy (pET) with surgery for operable, nonmetastatic, estrogen receptor–positive breast cancer. The studies included 22,821 patients, whose overall median age was 83.1 years; participants in randomized trials were younger than those in observational cohorts. Overall and breast cancer–specific survival from randomized trials were pooled using random-effects models, while observational findings were analyzed descriptively because of potential confounding by treatment selection.
For overall survival, pET was not associated with a statistically significant difference compared with surgery (hazard ratio, 1.14; 95% CI, 0.98-1.33), although the point estimate favored surgery. Across observational cohorts, median time to progression ranged from 19.7 months in tumor biology–unselected, tamoxifen-era cohorts to more than 50 months in cohorts selected for estrogen receptor status and treated with aromatase inhibitors. Tumor biology was consistently associated with progression risk.
The findings suggest that age alone may be insufficient when considering pET and support assessing tumor biology alongside frailty. However, the survival comparison was based on trials spanning five decades, and the observational data cannot establish comparative treatment effects. The abstract does not provide detailed criteria for selecting patients based on tumor biology or frailty.
In practice
For older women with operable, nonmetastatic estrogen receptor–positive breast cancer, this review found no statistically significant overall-survival difference between primary endocrine therapy and upfront surgery in pooled randomized-trial data. The findings support considering tumor biology and frailty rather than age alone when evaluating pET, but do not establish equivalence or provide validated selection criteria. Trials spanned five decades, and observational progression findings cannot determine comparative treatment effects.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
JAMA Network Open: Primary Endocrine Therapy vs Upfront Surgery for Older Women With Estrogen Receptor–Positive Breast Cancer ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.