Surgical de-escalation in elderly patients with invasive papillary carcinoma of breast: a SEER-based study

Invasive papillary carcinoma (IPC) of breast, rare and special entities, are insufficiently recognized. Our study aimed to investigate IPC in elderly patients, focusing on clinicopathological characteristics, prognosis, and surgical strategy efficacy. From the Surveillance, Epidemiology, and End Results (SEER) database, we retrospectively analyzed IPC in patients aged 65 + from 2000–2021, using Kaplan–Meier/log-rank tests for overall survival (OS) and cancer-specific survival (CSS) estimates, and Cox regression for prognostic factors. Propensity score matching (PSM) was applied to balance baseline characteristics. A total of 1475 eligible patients were enrolled in analysis. The 5 year OS and CSS for the entire cohort were 88.6% and 98.1%, respectively. Cox regression identified tumor size, the number of positive lymph nodes (LN +), PR status, and surgery as prognosis factors. Survival analysis showed that surgery improved prognosis in non-metastatic patients (P < 0.001), but not in metastatic ones (P > 0.05). Among patients without metastasis, 988 (69.9%) received BCS, while 426 (30.1%) received mastectomy. Additionally, 1114 (78.8%) patients underwent lymph node assessment, whereas 300 (21.2%) patients did not receive such an evaluation. 1414 patients were retained for comparative analysis. No survival difference was found between BCS and mastectomy (OS: P = 0.717; CSS: P = 0.241), or between LNE and no LNE groups (OS: P = 0.815; CSS: P = 0.213). IPC exhibits excellent prognosis and predominantly occurs in elderly women. Surgery is recommended for elderly IPC patients. Interestingly, elderly IPC patients show similar long-term survival after BCS or mastectomy, and no statistical difference in survival rates between LNE group and no-LNE group. These findings support that therapeutic de-escalation may be a viable consideration for select elderly patients with IPC.