Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

Tang, Zhuo-Wei; Ji, Yuzhu; Min, Yu; Zhang, Xiaohong; Xu, Wei-Yun; Zhao, Lijuan; Zhang, Jing; Long, Li; Feng, Jing; Wen, Ya-Qing

doi:10.3389/fendo.2022.856268

Cited by 6 publications

(3 citation statements)

References 42 publications

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“…This benefit persisted after stratification for node-negative BC (HR=0.80, p=0.007), node-positive BC (HR=0.76, p=0.006), and those with a comorbidity score >0 (HR=0.74, p=0.013). In the same way, Tang et al (79) have shown in elderly primary operable TNBC patients (≥70 years old) that age (HR=1.03 per year, p<0.001), T1c (HR=2.95) and chemotherapy (HR=0.79, p=0.035) were associated with lesser cancer-specific survival.…”

Section: Elderly Patient Outcomesmentioning

confidence: 66%

Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment

Houvenaeghel,

Cohen,

Gonçalves

et al. 2023

Front. Oncol.

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BackgroundElderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ~60% of deaths from BC occur in women aged 70 years and older. Only limited data are available on the prognostic impact of age according to treatment, especially in the triple-negative (TN) and Her2-positive because of the lower frequency of these subtypes in elderly patients. We report herein the results of a multicenter retrospective study analyzing the prognostic impact of age according to treatment delivered in TN and Her2-positive BC patients of 70 years or older, including comparison by age groups.MethodsThe medical records of 31,473 patients treated from January 1991 to December 2018 were retrieved from 13 French cancer centers for retrospective analysis. Our study population included all ≥70 patients with TN or Her2-positive BC treated by upfront surgery. Three age categories were determined: 70-74, 75-80, and > 80 years.ResultsOf 528 patients included, 243 patients were 70-74 years old (46%), 172 were 75-80 years (32.6%) and 113 were >80 years (21.4%). Half the population (51.9%, 274 patients) were TN, 30.1% (159) Her2-positive/hormone receptors (HR)-positive, and, 18% (95) Her2-positive/endocrine receptors (ER)-negative BC. Advanced tumor stage was associated with older age but no other prognostic factors (tumor subtype, tumor grade, LVI). Adjuvant chemotherapy delivery was inversely proportional to age. With 49 months median follow-up, all patient outcomes (overall survival (OS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS)) significantly decreased as age increased. In multivariate analysis, age >80, pT2-3 sizes, axillary macrometastases, lymphovascular involvement, and HR-negativity tumor negatively affected DFS and OS. Comparison between age >80 and <=80 years old showed worse RFS in patients aged > 80 (HR=1.771, p=0.031).ConclusionTN and Her2-positive subtypes occur at similar frequency in elderly patients. Older age is associated with more advanced tumor stage presentation. Chemotherapy use decreases with older age without worse other pejorative prognostic factors. Age >80, but not ≤80, independently affected DFS and OS.

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Section: Elderly Patient Outcomesmentioning

confidence: 66%

Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment

Houvenaeghel,

Cohen,

Gonçalves

et al. 2023

Front. Oncol.

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“…There are already many predictive models for the all-cause death of breast cancer based on the SEER database. We found that their overall prediction C statistic was between 0.70 and 0.72 ( 20 , 21 ). In addition, we found that, when their all-cause mortality models were constructed, the SEER predictors did not include some of the basic diseases of the patients and some regular indicators at the time of hospitalization.…”

Section: Discussionmentioning

confidence: 94%

Development and validation of a predictive nomogram for the specific mortality risk of luminal B breast cancer patients: a competing risk model based on real populations

Zhao¹,

Yan²,

Chen³

et al. 2023

Transl Cancer Res

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Background For clinical workers, disease-specific death is a better indicator of tumor severity. Breast cancer is the most prevalent malignancy in women. Luminol type B breast cancer is one of the biggest threats to women's health, and few studies have paid attention to its specific death. Early recognition of luminol type B breast cancer allows clinicians to assess the prognosis and develop more optimal treatment plans. Methods In this study, the basic information of luminal B population, clinical and pathological characteristics, treatment regimen and survival data were collected from the SEER database. The patients were randomly divided into a training group and a validation group. The single-factor and multi-factor competitive risk models were used to analyze the independent influencing factors of tumor-specific death, and the predictive nomogram based on the competitive risk model was constructed. The consistency index (C-index) and calibration curves over time were used to evaluate the accuracy of the predicted nomograms. Results This study included a total of 30,419 luminal B patient. The median follow-up period was 60 (IQR: 44–81) months. Among the 4,705 deaths during the follow-up period, 2,863 patients died specifically, accounting for 60.85% of the deaths. The independent predictive factors of cancer-specific mortality were: married, primary site, grade, stage, the primary site of operation, radiotherapy, chemotherapy, metastasis (lymph node, bone, brain, liver, lung), and Estrogen Receptor and Progesterone Receptor status. In the training cohort, the C-index of the predictive nomogram was 0.858, and the area under the receiver operating characteristic curve (AUC) for the first, third, and fifth years was 0.891, 0.864, and 0.845. The C-index of the validation cohort was 0.862, and the AUC for the first, third, and fifth years was 0.888, 0.872, and 0.849. The calibration curves of the training and validation cohorts showed that the predicted probability of the model was very consistent with the actual probability. And the 5-year survival rate according to the traditional survival analysis was 9.49%, while the 5-year specific mortality rate was only 8.88%. Conclusions The luminal B competing risk model we established has ideal accuracy and calibration.

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“…There are other gene score-based predictive models, including Oncotype DX and MammaPrint; however, these models have not been adequately validated in the elderly breast cancer population, as most of the patients recruited in these studies were under 65 years old (29, 30). Recently, there have been some novel prognostic models for elderly patients with breast cancer (31,32); however, the data for these nomograms from public databases were heterogeneous and the model was applicable to specialized groups such as patients with TNBC (31) or metastasis (32). The predictive model constructed in our study included not only the main clinicopathological features such as T stage, N stage, KI-67 status, and primary treatment methods such as operation type, but also chemotherapy and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

A nomogram for individually predicting overall survival for elderly patients with early breast cancer: a consecutive cohort study

Zhong

Zhou

et al. 2023

Front. Oncol.

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BackgroundElderly patients with breast cancer are highly heterogeneous, and tumor load and comorbidities affect patient prognosis. Prediction models can help clinicians to implement tailored treatment plans for elderly patients with breast cancer. This study aimed to establish a prediction model for breast cancer, including comorbidities and tumor characteristics, in elderly patients with breast cancer.MethodsAll patients were ≥65 years old and admitted to the Peking Union Medical College Hospital. The clinical and pathological characteristics, recurrence, and death were observed. Overall survival (OS) was analyzed using the Kaplan–Meier curve and a prediction model was constructed using Cox proportional hazards model regression. The discriminative ability and calibration of the nomograms for predicting OS were tested using concordance (C)-statistics and calibration plots. Clinical utility was demonstrated using decision curve analysis (DCA).ResultsBased on 2,231 patients, the 5- and 10-year OS was 91.3% and 78.4%, respectively. We constructed an OS prediction nomogram for elderly patients with early breast cancer (PEEBC). The C-index for OS in PEEBC in the training and validation cohorts was 0.798 and 0.793, respectively. Calibration of the nomogram revealed a good predictive capability, as indicated by the calibration plot. DCA demonstrated that our model is clinically useful.ConclusionThe nomogram accurately predicted the 3-year, 5-year, and 10-year OS in elderly patients with early breast cancer.

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Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

Cited by 6 publications

References 42 publications

Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment

Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment

Development and validation of a predictive nomogram for the specific mortality risk of luminal B breast cancer patients: a competing risk model based on real populations

A nomogram for individually predicting overall survival for elderly patients with early breast cancer: a consecutive cohort study

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