BACKGROUND Despite data demonstrating the safety of omitting axillary surgery in older women with early-stage breast cancer, the incidence of axillary surgery remains high. It was hypothesized that the prevalence of nodal positivity would decrease with advancing age. METHODS The National Cancer Data Base was used to construct a cohort of adult women with early-stage, clinically node-negative, estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative breast cancer treated between 2013 and 2015. Multivariable logistic regression was used to assess the relationship between age and nodal positivity, and this was stratified by the axillary surgery category. Modified Poisson regression was used to estimate the proportion of women receiving adjuvant therapy according to age and nodal status. RESULTS The incidence of axillary surgery among women aged 70 and older (n = 51,917) remained high nationwide (86%). There was a significant decrease in nodal positivity with advancing age in women with early-stage, ER+, clinically node-negative breast cancer from the youngest cohort up to patients aged 70 to 89 years, and this was independent of histologic subtype (ductal vs lobular), race, comorbidities, and socioeconomic factors. Overall, less than 10% of women aged 70 or older who underwent surgery had node-positive disease, regardless of axillary surgery type, and almost 95% of node-positive patients aged 70 or older were at pathological stage N1mi or N1. CONCLUSIONS Axillary surgery may be safely omitted for many older women with ER+, clinically node-negative, early-stage breast cancer. Nodal positivity declines with advancing age, and this suggests varied biology in older patients versus younger patients.

中文翻译：

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早期激素受体阳性乳腺癌女性的淋巴结阳性率随着年龄的增长而降低。

背景 尽管有数据表明在患有早期乳腺癌的老年女性中省略腋窝手术是安全的，但腋窝手术的发生率仍然很高。据推测，淋巴结阳性的患病率会随着年龄的增长而降低。方法 国家癌症数据库用于构建 2013 年至 2015 年间治疗的早期、临床淋巴结阴性、雌激素受体阳性 (ER+)、人表皮生长因子受体 2 阴性乳腺癌成年女性的队列。多变量逻辑回归用于评估年龄和淋巴结阳性之间的关系，并按腋窝手术类别进行分层。修正泊松回归用于根据年龄和淋巴结状态估计接受辅助治疗的女性比例。结果 在全国范围内，70 岁及以上女性（n = 51,917）的腋窝手术发生率仍然很高（86%）。从最年轻的队列到 70 至 89 岁的患者，早期 ER+、临床淋巴结阴性乳腺癌患者的淋巴结阳性率随着年龄的增长而显着下降，这与组织学亚型（导管型 vs 小叶型）无关)、种族、合并症和社会经济因素。总体而言，无论腋窝手术类型如何，接受手术的 70 岁或以上的女性中，只有不到 10% 的患者患有淋巴结阳性疾病，并且几乎 95% 的 70 岁或以上的淋巴结阳性患者处于病理分期 N1mi 或 N1。结论 对于许多患有 ER+、临床淋巴结阴性、早期乳腺癌的老年女性，可以安全地省略腋窝手术。淋巴结阳性率随着年龄的增长而下降，