E93: Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients

Introduction: Given the predominantly female aging US population, there is a needed interest in the appropriate use of breast cancer surgery for the elderly. Our goal is to evaluate the effects of frailty and malnutrition on geriatric breast cancer surgery outcomes using the ACS 5-factor modified frailty index (MFI) and Global Leadership Initiative on malnutrition (GLIM) definition.

Methods: A single-institution retrospective review of a prospective database of geriatric breast cancer surgery patients (2000-2016) was performed; cases were stratified into 3 groups: non-frail (MFI=0), pre-frail (MFI=1), or frail (MFI≥2), as well as into no malnutrition, moderate malnutrition and severe malnutrition per GLIM. Demographics, comorbidities, 90-day postop outcomes, and 5-year followup were analyzed using Kaplan Meier survival curves, Univariate/Multivariate logistic regression model, and Univariate/Multivariate Cox model with statistical significance of p≤0.05.

Results: At diagnosis among 436 patients, age range 62-101 years (yrs), 213 (48.9%) were >80 yrs and 69 (15.8%) had malnutrition. The mean age at surgery was 77 yrs with 377 (86.5 %) alive at 5 yrs. 126 (29.5%) were staged T2 or above, 76 (17.9%) were N1 and 14 (3.3%) were N2-3. 266 (61.6%) had lumpectomy and 384 (88.7%) had sentinel lymph node biopsy; 35 (8.1%) had axillary dissection. 162 (37.2%) patients had MFI of 0 vs 274 (62.8%) with MFI > 0, with hypertension as the most common (n=250, 57.3%) comorbid factor.79 patients (18.1%) had postop readmission within 90 days. Return to OR was the most predominant complication (60 cases,13.8%). Of the 59 (13.5%) patients that died within 5 years, 50 (84.7%) had surgery ≥80 years old; 9/59 (15.3%) died with metastatic breast cancer. Patients ≥80, MFI >0 and PR-negative tumors were associated with worse 5-year survival. There was no survival difference in patients >80 with or without malnutrition (HR =1.01, p=0.971) and there was no difference in type of surgery (p=0.560). On multivariate regression, complications were associated with age< 80, readmission, MFI >0, and a history of HTN; serious complications were associated with age< 80, readmission, anticoagulation, and not receiving adjuvant endocrine therapy.

Conclusions: MFI showed a significant predictive value for 5-year survival for patients > 80 and should be part of the preoperative evaluation before breast surgery. MFI >0 was associated with any complications but was not predictive of serious complications. Malnutrition did not correlate with survival or complication rates.