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Aims Minimum volume thresholds were introduced in France in 2008 to improve the quality of cancer care. We investigated whether/how the quality of treatment decisions in breast cancer surgery had evolved before and after this policy was implemented. Methods We used Hospital Episode Statistics for all women having undergone breast conserving surgery (BCS) or mastectomy in France in 2005 and 2012. Three surgical procedures considered as better treatment options were analyzed: BCS, immediate breast reconstruction (IBR) and sentinel lymph node biopsy (SLNB). We studied the mean rates and variation according to the hospital profile and volume. Results Between 2005 and 2012, the volume of breast cancer surgery increased by 11% whereas one third of the hospitals no longer performed this type of surgery. In 2012, the mean rate of BCS was 74% and similar in all hospitals whatever the volume. Conversely, IBR and SLNB rates were much higher in cancer centers (CC) and regional teaching hospitals (RTH) [IBR: 19% and 14% versus 8% on average; SLNB: 61% and 47% versus 39% on average]; the greater the hospital volume, the higher the IBR and SLNB rates (p < 0.0001). Overall, whatever the surgical procedure considered, inter-hospital variation in rates declined substantially in CC and RTH. Conclusions We identified considerable variation in IBR and SLNB rates between French hospitals. Although more complex and less standardized than BCS, most clinical guidelines recommended these procedures. This apparent heterogeneity suggests unequal access to high-quality procedures for women with breast cancer. [ABSTRACT FROM AUTHOR]

Aim To report initial results of observation as well as surgery in patients with desmoid tumors (DTs) of the breast, a rare tumor for which data are scarce. Patients and methods The initial approaches were categorized as either front-line loco-regional treatment [(surgery or radiotherapy group, SRG) n = 20] or initial observation [(no surgery/no radiotherapy group, NSRG) n = 11]. Results A total of 27 women and 4 men were assessed between 1992 and 2013 and included in this study. Patient characteristics were adequately balanced in the 2 groups. Fifteen patients (48.4%) had a past history of breast surgery in the previous 24 months. The median initial DT size on MRI was 50 mm. The median follow-up was 36 months. In the SRG, 8/20 patients (40%) experienced recurrence. The median time to recurrence was 29 months. During the study period, 6 patients in the SRG (30%) received a mastectomy at the time of diagnosis (n = 3) or at relapse (n = 3), 7 patients (35%) received a thoracic wall resection and 8 patients (40%) received radiotherapy at the time of diagnosis (n = 2) or at recurrence (n = 5). In the NSRG, the median tumor size change was −4 mm (range −13 to +20). Three patients changed treatment strategies during the observation period; one received surgery, and 2 were administered anti-hormonal treatment. Conclusions Loco-regional treatments of breast DTs resulted in undesired disfigurement. Front-line observation yielded encouraging results and could enable the identification of patients who require loco-regional treatment. This strategy needs further evaluation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Currently, the benefit of chemotherapy (CT) in node-negative breast carcinoma (NNBC) is discussed. The evaluation of classical clinical and histological factors is limited to assess individual outcome. A statistical model was developed to improve the prognostic accuracy of NNBC. Methods: A total of 305 node-negative breast carcinomas who underwent surgery (+/– radiotherapy) but no adjuvant treatment were selected. Putative prognosis factors including age, tumour size, oestrogen receptor (ER), progesterone receptor (PgR), Scarff–Bloom–Richardon (SBR) grading, urokinase plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1) and thymidine kinase (TK) were evaluated. The developed model was internally validated using Harrell’s concordance index. A prognosis index (PI) was proposed and compared with Adjuvant! Online program. Results: Age (p <0.001), pathological tumour size (pT) (p< 0.001), PgR (p =0.02), and PAI-1 (p ⩽0.001) were included in the Cox regression model predicting Breast cancer specific survival (BCSS) at 5-years. Internal validation revealed a concordance index of 0.71. A PI score was derived from our nomogram. The PI score was significantly associated with BCSS (hazard ratio (HR): 4.1 for intermediate, p =0.02, HR: 8.8, p <0.001 for high group) as compared to Adjuvant! Online score (HR: 1.4, p =0.14). Conclusion: A nomogram can be used to predict probability survival curves for individual breast cancer patients. [Copyright &y& Elsevier]

Background The aim of neoadjuvant chemotherapy is to increase the likelihood of successful breast conservation surgery (BCS). Accurate identification of BCS candidates is a diagnostic challenge. Breast Cancer Index (BCI) predicts recurrence risk in estrogen receptor + lymph node − breast cancer. Performance of BCI to predict chemosensitivity based on pathological complete response (pCR) and BCS was assessed. Methods Real-time RT-PCR BCI assay was conducted using tumor samples from 150 breast cancer patients treated with neoadjuvant chemotherapy. Logistical regression and c-index were used to assess predictive strength and additive accuracy of BCI beyond clinicopathologic factors. Results BCI classified 42 % of patients as low, 35 % as intermediate and 23 % as high risk. Low BCI risk group had 98.4 % negative predictive value (NPV) for pCR and 86 % NPV for BCS. High versus low BCI group had a 34 and 5.8 greater likelihood of achieving pCR and BCS, respectively (P = 0.0055; P = 0.0022). BCI increased c-index for pCR (0.875–0.924; P = 0.017) and BCS prediction (0.788–0.843; P = 0.027) beyond clinicopathologic factors. Conclusions BCI significantly predicted pCR and BCS beyond clinicopathologic factors. High NPVs indicate that BCI could be a useful tool to identify breast cancer patients who are not eligible for neoadjuvant chemotherapy. These results suggest that BCI could be used to assess both chemosensitivity and eligibility for BCS. [ABSTRACT FROM AUTHOR]

Abstract: Achieving a mastectomy occurs in one third of the acts of breast cancer surgery. In the present context, the increase in the diagnosis of early breast cancer, including widespread or multifocal forms, the possibility of a reconstruction at the same time is discussed. It will be proposed in a specific context, taking into account various factors: oncological (characteristics of the tumor, adjuvant treatments), clinical (smoking, comorbidity) and psychological (choice of the patient). The technique of mastectomy will be adapted to the indication and choice of reconstruction procedure. Including the preservation of the nipple-areola complex, or the skin envelope will be possible for some guidance. The reconstruction is possible with the use of breast implants, or musculocutaneous flaps or by the combination of both. Some of these techniques are associated with significant morbidity, and appropriate selection of procedure to the patient will guarantee a lower risk of complications. [Copyright &y& Elsevier]

Abstract: Placenta accreta is a life-threatening obstetrical condition requiring a multidisciplinary approach. Despite identified obstetrical risk factors, the diagnosis is often made at the time of delivery. Recent advances in biology could allow a prenatal screening of placenta accreta with the identification of biological markers in maternal blood including cell-free fetal DNA, placental mRNA, and DNA microarray. These promising technologies can detect the presence of anomalies and should play a future role in developing a better understanding of placental invasion. Ultrasound imaging is popular due to its low cost and accessibility and widely used for the screening of placenta location and potential abnormal development. This exam is associated with high sensitivity and specificity for diagnosis of placenta accreta when specific defined criteria are used for the diagnosis. A placental MRI provides a morphological description, as well as recently demonstrated topographical information that optimizes diagnosis and surgical management. The screening of placenta accreta should be improved with the use of a combination of these diagnostic techniques and benefit high-risk populations with a reduction in morbidity. [Copyright &y& Elsevier]

Aim: This study aimed to evaluate the role of specimen radiography in predicting margin status for non-palpable breast malignancies. Methods: We retrospectively reviewed the clinical and pathological data together with specimen radiographs of 164 women with ductal carcinoma in situ, who were referred to our centre between January 1997 and December 2000. In all cases microcalcifications were discovered on mammography. Lesions were localized preoperatively using a guide-wire. Specimen radiography findings and clinicopathological data were correlated with pathological findings. Results: Findings comprised 122 pure ductal carcinomas in situ (74%) and 42 mixed carcinomas, both infiltrating and in situ (26%). On the specimen radiographs, the lesions were close (<1mm) to one edge of the lumpectomy in 34 (21%) cases. Histologically, there were 103 positive resection margins (<1mm, 63%) and only 61 negative margins (> or =1mm, 37%). On univariate analysis, factors associated with positive resection margins were found to be distance from microcalcifications to edge of lesion on specimen radiographs, and radiological multifocality. On multivariate analysis (logistic regression), a radiological margin <5mm and multifocality were the only risk factors for close histological margins. Radiological margins were not associated with surgical findings. Conclusion: Our results demonstrate that there is a correlation between specimen radiographs and histological results. The clinical relevance of this should be evaluated in a prospective study. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess®. Patients and methods: A retrospective study of all women who underwent cervical ripening with Propess® during the study period from 1st January 2002 to 31st December 2004 was carried out. A total of 130 patients who experienced Propess® was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery, failure of labor, maternal morbidity were recorded. Results: Indications for induction of labor were: post-term pregnancies in 18.5%, pre-eclampsia in 20.8%, oligohydroamnios in 18.5%, post-term pregnancy and oligohydramnios in 10.8%, intra-uterine fetal growth in 6.9%, premature rupture of membranes in 6.9%, diminution of fetal mobility in 6.1% and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess® group had a 3.5 fold higher risk of Cesarean section [95% CI: 1.5–8.3; P <0.04]. There was no case of maternal or fetal death. There was no difference in incidence of maternal complications, and post-partum haemorrhage. Discussion and conclusion: Use of vaginal pessary Propess® does not induce adverse maternal or fetal morbidity. However, it was associated with a higher incidence of Cesarean delivery. [Copyright &y& Elsevier]

Abstract: Objective. – To determine the most relevant findings for diagnosis of adnexal torsion and predictive factors of adnexal necrosis. Patients and methods. – Clinical, biological, ultrasound, pathologic and surgical findings in surgically confirmed cases of adnexal torsion treated over a five-year period in a gynaecologic emergency department were retrospectively reviewed. Results. – A total of 52 cases of adnexal torsion were studied. Abdominal pain was present in 80.8%, vomiting in 13.5% and fever only in 9.6%. Leukocytosis was noted in 19 (36.5%). The most frequent ultrasound findings were ovarian enlargement in 22 patients (42.3%), ovarian cysts in 26 (50%), and hyperechogenic parenchyma with follicles along the periphery of the ovary in 13 (25%). Age over 40 years and a delay to surgery longer than 10 hours were significantly associated with diagnosis of adnexal necrosis. Discussion and conclusion. – Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and radiological evidence. No predictive factors of necrosis are found. Risk of adnexal torsion is potentially increased by waiting period for surgery and patient''s age. [Copyright &y& Elsevier]

Le cancer du sein et sa prise en charge restent un problème majeur de santé publique chez la femme. L'épidémiologie des complications liée à la radiothérapie après une reconstruction mammaire immédiate prothétique (RMIP) reste insuffisante et ses conséquences esthétiques mal définies. L'objectif de ce travail était de comparer les taux de complications et les résultats esthétiques des reconstructions mammaires immédiates (RMI) par prothèse avec et sans radiothérapie, afin de déterminer les facteurs de risques de complications et de mauvais résultats esthétiques. Une étude rétrospective a été conduite entre janvier 2014 et décembre 2016 portant sur des patientes atteintes d'un cancer du sein et devant bénéficier d'une mastectomie totale sous cutanée (MTSC) avec une RMIP. Le critère d'évaluation était le taux d'échec de reconstruction et le rendu esthétique global, les critères secondaires évaluaient le taux de complications précoces et tardives. Il fut réalisé une analyse multivariée pour déceler des facteurs de risques prédictifs de complication. Trois cent trente-trois patientes ont été incluses : 157 dans le bras radiothérapie et 176 pour le groupe sans radiothérapie. Les caractéristiques préopératoires étaient comparables. Le suivi moyen était de 1 à 3 ans sans perdu de vue. Le résultat sur le critère de jugement principal montrait que les patientes qui avaient bénéficié d'une radiothérapie avaient le même risque d'échec de reconstruction que les patientes non irradiées. L'analyse en sous-groupe ne révélait aucune différence significative : 12,7 % d'échec de reconstruction pour le bras irradié versus 12,5 %. Concernant l'évaluation de l'altération des résultats esthétiques, il fut constaté comme différence un meilleur taux de patientes avec d'« excellents » résultats dans le bras sans radiothérapie (35 % vs 8,2 %). Les résultats sur les critères secondaires étaient comparables. La radiothérapie chez les patientes bénéficiant d'une RMIP n'augmente pas le risque d'échec de reconstruction et de mauvais résultats esthétiques comparativement aux patientes non irradiées. Il est donc licite de proposer pour toutes patientes devant bénéficier d'une MTSC suivie d'une radiothérapie, une RMIP et ainsi de leur éviter une reconstruction secondaire, plus impactante sur le plan psychologique. Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results. We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications. Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3 years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable. Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful. [ABSTRACT FROM AUTHOR]

Résumé La reconstruction mammaire immédiate a montré de nombreux avantages en termes de résultats esthétiques et d'amélioration de la qualité de vie des patientes comparativement à la reconstruction mammaire secondaire. Les antécédents de radiothérapie ou la nécessité de traitement adjuvants (radiothérapie, chimiothérapie...) ne sont plus des contre-indications à la reconstruction mammaire immédiate. Il est, cependant, nécessaire de respecter certaines règles pour diminuer le risque de complications : le choix de la technique de reconstruction, la gestion de l'enveloppe cutanée en fonction de la forme du sein que l'on souhaite reconstruire, les délais entre le 1er et le 2e temps de reconstruction en fonction d'une éventuelle chimiothérapie ou radiothérapie adjuvante. Summary Immediate breast reconstruction showed many advantages in terms of aesthetic and functional results and improvement of quality of life when compared to delayed breast reconstruction. Previous radiotherapy or the use of adjuvant treatments such as radiation therapy, or chemotherapy are no longer a contraindication for immediate breast reconstruction. However, it is important to respect certain rules in order to decrease the risk of complications: the choice of reconstruction technique, the management of the skin envelope according to the breast shape you want to create, the time delay between the first and the second stage of reconstruction depending on a possible adjuvant treatment. [ABSTRACT FROM AUTHOR]

Résumé Le vert d’indocyanine est un colorant soluble dans l’eau, à élimination hépatique et excrétion biliaire. Illuminé par une source laser infrarouge, le vert d’indocyanine émet une lumière fluorescente dans le spectre du proche-infrarouge qui est invisible à l’œil nu mais qui peut être visualisée à l’aide d’une caméra proche-infrarouge. Lorsqu’il est injecté en intraveineux, il peut être utilisé comme marqueur de la perfusion cutanée. Injecté en sous-cutané, il permet de cartographier le réseau lymphatique. En chirurgie sénologique et en reconstruction mammaire, il est utilisé pour repérer le ganglion sentinelle chez les patientes atteintes d’un cancer du sein, pour évaluer la perfusion des lambeaux cutanés de mastectomie, pour évaluer la perfusion des lambeaux libres utilisés en reconstruction mammaire autologue et dans la prise en charge du lymphœdème secondaires des membres. Le vert d’indocyanine pourrait être enfin utilisé pour guider l’excision des tumeurs non palpables du sein. Summary The Indocyanine green (ICG) is a soluble dye that is eliminated by the liver and excreted in bile. When illuminated by an near-infrared light, the ICG emits fluorescence in the near-infrared spectrum, which can be captured by a near-infrared camera-handled device. In case of intravenous injection, ICG may be used as a marker of skin perfusion. In case of interstitial injection, it may be useful for lymphatic network mapping. In oncological and reconstructive breast surgery, ICG is used for sentinel lymph node identification, to predict mastectomy skin flap necrosis, to assess the perfusion of free flaps in autologous reconstruction and for diagnosis and treatment of upper limb secondary lymphedema. Intraoperative indocyanine green fluorescence might also be used to guide the excision of nonpalpable breast cancer. [ABSTRACT FROM AUTHOR]

This study evaluates the long-term outcomes of a retrospective cohort of breast cancer (BC) patients who had received curatively intended premastectomy radiation therapy (RT). We analysed locoregional control, disease-free survival (DFS) and overall survival (OS), pathological complete remission (pCR), predictors thereof, and immediate safety. The series consisted of 187 patients with a median age of 49 years [43–60] and T2–T4 or N2 tumours. Between 1970 and 1984, they had received slightly hypofractionated RT to the whole breast, ipsilateral supraclavicular fossa and axilla ± the internal mammary chain (45–55 Gy/18 fractions of 2.5 Gy/34 days) systematically followed by a modified radical mastectomy with an axillary dissection. No other preoperative treatment was given. Among the 166 centrally reviewed tumour biopsy specimens, 22% had a triple-negative (TN) phenotype, 17% were HER2 3 + or amplified and 61% were ER+. The median follow-up was 32 years [23–35]. The 25-year locoregional control rate was 89% [93%–82%] and the 25-year DFS and OS rates were identical, 30% [24%–37%]. A pCR in the tumour and lymph nodes had been achieved in 18 among all patients (10%), but in 26% with TN disease. In the multivariate analysis, the TN status was the only predictive factor of pCR (OR = 5.49, 95% confidence interval [CI] 1.87–16.1, p = 0.002). Also, the pN status (HR = 1.69, [1.28–2.22], p = 0.0002) and TN subtype (HR = 1.80, [1.00–3.26], p = 0.05) exerted a significant prognostic impact on OS. The postoperative complication rate (grade >2) was 19% with 4.3% of localized skin necrosis. Preoperative RT followed by radical surgery is feasible and associated with good long-term locoregional control. [ABSTRACT FROM AUTHOR]

Résumé Les indications de reconstruction mammaire immédiate s'étendent aux carcinomes infiltrants, du fait de nouvelles techniques de couverture des implants par matrice et du fait du développement des lambeaux perforants. Ces techniques autorisent les traitements adjuvants. Il faut, cependant, que la décision de reconstruction immédiate soit encadrée par l'avis de la RCP oncologique et il faut aussi évaluer les bénéfices et risques au regard de la morphologie de la patiente et de ses comorbidités. Le type de mastectomie choisi : classique ou avec conservation de peau et/ou avec conservation de la plaque aréolo-mamelonnaire (PAM) dépend de la forme et du volume du sein, de la localisation de la tumeur dans le sein et par rapport à la PAM. Nous définissons un algorithme pour permettre en cas de mastectomie thérapeutique avec ou sans radiothérapie adjuvante, une reconstruction immédiate par prothèse ou lambeau libre ou pédiculé. Summary Immediate breast reconstruction indications extend to infiltrating carcinomas, due to new matrix implant coverage techniques and the development of perforator flaps. These techniques allow adjuvant treatments. However, the decision of immediate reconstruction must be discussed with the oncological multidisciplinary team and the benefits/risks must also be evaluated in relation to the morphology of the patients and their co-morbidities. The chosen type of mastectomy: conventional or skin sparing and/or nipple sparing depends on the shape and volume of the breast, the localization of the tumor in the breast and the distance from the nipple areola complex (NAC). We describe an algorithm to allow, in the case of therapeutic mastectomy with or without adjuvant radiotherapy, an immediate reconstruction with implants or free or pedicled flaps. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal morbidity after Thierry's spatulas or vacuum-assisted deliveries. Patients and methods: Retrospective study, at the French hospital la Conception, in Marseilles. All successful instrumental deliveries between November 2003 and May 2005 were reviewed, that is to say 264. Univariate and multivariate analyses were performed comparing maternal morbidity in the two groups. The primary outcome measure was perineal trauma. Secondary outcomes were blood loss and duration of hospitalization. Results: Among the 264 deliveries, there were 96 vacuum deliveries and 168 Thierry's spatulas extraction. Thierry's spatulas were used more often in nulliparous patients (<0.001). Patients in the group of Thierry's spatulas have a higher rate of epidural analgesia (p =0.05), a longer duration of first (p =0.002) and second stage of labor (p =0.03). There was no difference in incidence of sphincter tears between women who underwent Thierry's spatulas and those who underwent vacuum delivery with respective incidence of 4.2 and 3.2% (p =0.67). There was a significant difference in post-partum hemoglobin value with a higher blood loss in the group of Thierry's spatulas (<0.001). Mean duration of hospitalization was longer in the group with Thierry's spatulas (5.6 days) than in the group who underwent vacuum delivery (4.7 days) (p <0.001). Discussion and conclusion: Incidence of third degree tears was similar between the vacuum and Thierry's spatulas group. Deliveries with vacuum are associated with less blood loss and a shorter hospitalization stay. [Copyright &y& Elsevier]

Objective: This study was undertaken to evaluate prevalence of low urinary tract symptoms (LUTS) after Thierry's spatula delivery at first pregnancy. Patients and methods: A retrospective study of 236 primiparous with instrumental delivery or spontaneous delivery who had delivered from January 2001 to December 2002. Low urinary tract symptoms (LUTS) were evaluated one year after delivery with a questionnaire. Incidence of LUTS was compared depending on mode of delivery. Results: Of the 236 patients included, 88.1% replied to the questionnaire, 106 who delivered spontaneously and 102 who underwent Thierry''s spatula delivery. The incidence of urinary incontinence was similar after instrumental deliveries and after spontaneous vaginal deliveries (34.9 versus 24.5%, p =0.10). In univariate analysis, symptoms of urinary urgency and urinary frequency were higher after instrumental delivery than after spontaneous delivery, respectively, 34.9 versus 22.5%, p =0.049 and 19.8 versus 8.8%, p =0.03. After controlling for confounding factors, no difference in LUTS was observed between the two groups; the respective adjusted odds-ratios (95% IC) were 1,5 (0.8–3) for urinary incontinence, 1.7 (0.9–3.5) for urgency and 2.5 (0.9–6.3) for urinary frequency. Discussion and conclusion: One year after delivery, one third of patients will present urinary incontinence and more than 50% will complain of bladder instability symptoms. Compared to spontaneous vaginal delivery, the use of Thierry''s spatulas at first pregnancy does not induce higher risk of LUTS. [Copyright &y& Elsevier]

Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ∼60% of deaths from BC occur in women aged 65 years and older. The management of elderly women with early BC requires careful evaluation of risks and benefits of available treatment options. Clinical trials for elderly patients in the adjuvant setting are lacking, and efficacy results obtained in general population cannot be directly extrapolated to elderly patients without specific evidences. Therefore, we examined factors associated with the prescription of adjuvant chemotherapy (aCT) and the impact of this treatment on overall survival (OS) in a large cohort of patients aged 65 years and older. Patients were retrospectively identified from a large cohort of 23,134 early BC patients who underwent primary surgery in 18 academic centres between 1990 and 2014. A binary logistic regression was built to identify the factors associated with aCT administration. The impact of aCT on OS was analysed using a multivariate Cox regression model including age, histology, grade, tumour size, lymphovascular invasion (LVI), nodal status and endocrine therapy (ET) and endocrine receptors (ER). A propensity score-based matching analysis was performed. Of 6605 patients aged 65 years and older, 1493 received aCT (22.6%). Administration of aCT was predominantly associated with macroscopic lymph node involvement (LNi) and ER-negative status but common predictors, such as age < 80 years, ductal histology, tumour size ≥ 20mm, ET and tumour grade were also found as statistically significant. In a Cox model including age, histology, LVI, tumour size, LNi, ET, ER and grade, aCT was significantly associated with better OS (HR 0.71, 95% CI 0.58 to 0.86; p < 0.001). Ten-year OS estimates in case-matched patients for propensity score analysis were 76.8% (95% CI 76.6 to 77.1) in the aCT group vs. 61.5% (95% CI 61.3 to 61.7) without aCT (p < 0.0001). Interestingly, this benefit was maintained in the over-80s subgroup. The factors associated with aCT use in the elderly are similar to those usually found in younger age groups. By highlighting an OS benefit, even in the "very old" subgroup, our results may help clarifying the role of aCT in elderly patients. Houvenaeghel Gilles. Has not received any funding. All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]