Determinants of early distant metastatic disease in elderly patients with breast cancer

Background The purpose of this analysis was to determine predictors of early distant metastasis in elderly breast cancer patients receiving hormonal therapy. Methods We analyzed data from 938 patients in the North American Fareston Tamoxifen Adjuvant Trial ≥65 years old to determine predictors of early metastatic disease. Results The median patient age was 73 (range 65 to 100). With a median follow-up of 34 months, 17 patients (1.8%) developed distant metastases. The median time to distant metastasis was 21 months. On univariate analysis, significant predictors of distant metastatic disease were as follows: progesterone receptor status (P = .032), lymphovascular invasion (P = .020), tumor grade (P = .007), tumor size (P< .01), and number of metastatic nodes (P< .01). On multivariate analysis, only the number of positive nodes (P = .029) remained significant. Patients with ≥4 positive nodes were more likely to develop early metastases than those with 0 to 3 positive nodes (odds ration 20.304; 95% confidence interval 2.777–148.456, P = .003). Conclusions Lymph node status in the elderly breast cancer patient treated with hormonal therapy alone is a strong predictor of early distant recurrence.