Quality Indicators Compliance and Survival Outcomes in Breast Cancer according to Age in a Certified Center

Abstract

Age as a breast cancer (BC) prognostic factor remains debatable. Several studies have investigated clinicopathological features at different ages, but few make an age group direct comparison. The European Society of Breast Cancer Specialists quality indicators (EUSOMA-QIs) allow a standardized quality assurance of BC diagnosis, treatment, and follow-up. Our objective was to compare clinicopathological features, compliance to EUSOMA-QIs and BC outcomes in three age groups (≤45 years, 46–69 years, and ≥70 years). Data from 1580 patients with staged 0–IV BC from 2015 to 2019 were analyzed. The minimum standard and desirable target on 19 mandatory and 7 recommended QIs were studied. The 5-year relapse rate, overall survival (OS), and BC-specific survival (BCSS) were also evaluated. No meaningful differences in TNM staging and molecular subtyping classification between age groups were found. On the contrary, disparities in QIs compliance were observed: 73.1% in ≤45 years and 46–69 years women vs. 54% in older patients. No differences in loco-regional or distant progression were observed between age groups. Nevertheless, lower OS was found in older patients due to concurrent non-oncological causes. After survival curves adjustment, we underscored evidence of undertreatment impacting BCSS in ≥70 years women. Despite a unique exception—more invasive G3 tumors in younger patients—no age-specific differences in BC biology impacting outcome were found. Although increased noncompliance in older women, no outcome correlation was observed with QIs noncompliance in any age group. Clinicopathological features and differences in multimodal treatment (not the chronological age) are predictors of lower BCSS.

Identification of age‐ and immune‐related gene signatures for clinical outcome prediction in lung adenocarcinoma

“…For example, lower OS was found in older breast cancer patients due to concurrent non‐oncological causes in a cohort of 1580 Portuguese women. 49 Age above 70 years and Charlson Comorbidity Index higher than three are also associated with reduced survival after radical cystectomy in a cohort of 334 bladder cancer patients. 50 In addition, older patients may receive less aggressive treatments compared to younger patients due to concerns about treatment toxicity and overall health, which may result in lower efficacy in eradicating cancer cells.…”

“…Since older patients often have other health conditions which reduce organ function and physiological reserves, they are more fragile and their expected lifespan is shorter than younger patients. For example, lower OS was found in older breast cancer patients due to concurrent non‐oncological causes in a cohort of 1580 Portuguese women 49 . Age above 70 years and Charlson Comorbidity Index higher than three are also associated with reduced survival after radical cystectomy in a cohort of 334 bladder cancer patients 50 .…”