Abstract P2-08-13: Survival in women with de novo metastatic breast cancer: Comparison of real-world evidence from publicly-funded Canadian province and the United States by insurance status
Notice bibliographique
Résumé
Abstract Background: Access to cancer screening, diagnosis and treatment in the United States (US) is affected by insurance status; whereas, access within a publicly-funded health care system is similar across the whole population. The aim of this study was to compare overall survival (OS) of de novo stage IV (metastatic) breast cancer (BC) pts in a Canadian province and in the US according to insurance status. Methods: All female pts 18-64 yrs of age diagnosed with de novo stage IV BC from Jan 1, 2010 through Dec 31, 2014 with available biomarker information were included. Pts diagnosed by death certificate or autopsy and pts ≥ 65 yrs were excluded due to unreliable insurance status classification in the US SEER database. The Alberta cohort (AB) was obtained from the Alberta Health Services CancerControl Breast Data Mart (BDM), a repository of information on all pts diagnosed with their first BC diagnosis from Jan 1, 2004 onwards in the province of Alberta, Canada. The U.S. cohort was obtained from the US Surveillance, Epidemiology, and End Results (SEER) program cancer database. A total of 9,604 pts from the SEER database and 294 pts from the BDM were analyzed. OS was evaluated over a 2 yr period and median and 2 yr OS were estimated. Unadjusted associations were compared using the log-rank test, and hazard ratios (HR) were estimated using the Cox proportional hazards model with US insured set as reference group. Results: Comparison of AB and US cohorts showed no differences based on age group (18-49 vs 50-64), yr of diagnosis or receipt of primary surgery. The AB cohort had a higher incidence of hormone receptor positive (HR+), similar frequency of HER2+, and a lower incidence of triple negative (TN) BC relative to the US cohort: HR+ 60.5% vs 56.4%; HER2+ 30.6% vs 28.8%; and TN 8.8% vs 14.8%, respectively [p=0.017]. The distribution of HR+, HER2+ and TN BC was consistent between the SEER insured, Medicaid and uninsured groups. AB cohort estimated 2 yr OS was 70.1%, similar to the insured group of 66.0% and significantly better than the Medicaid or uninsured pts [53.2% and 50.9%; p<0.0001]. Subgroup analysis based on biomarker status, surgery and age group showed similar results. Adjusting for these variables, AB OS remained similar to the insured group [HR=0.92 (0.74-1.15) p=0.474] with worse OS noted in the Medicaid and uninsured populations [HR=1.44 (1.32-1.56) and HR=1.53 (1.33-1.77) p<0.001, respectively]. HR+HER2+TNNo SurgerySurgery18-4950-64InsuredReference Group: HR=1.00AB0.92 (0.68-1.24) p=0.5841.15 (0.76-1.72) p=0.5090.84 (0.49-1.42) p=0.5070.91 (0.71-1.17) p=0.4660.71 (0.45-1.11) p=0.1330.84 (0.56-1.27) p=0.4080.87 (0.67-1.12) p=0.284Medicaid1.43 (1.27-1.61) p<0.0011.57 (1.32-1.87) p<0.0011.37 (1.18-1.60) p<0.0011.46 (1.33-1.59) p<0.0011.55 (1.33-1.81) p<0.0011.75 (1.52-2.00) p<0.0011.47 (1.34-1.61) p<0.001Uninsured1.76 (1.44-2.15) p<0.0011.64 (1.20-2.22) p<0.0011.56 (1.20-2.05) p=0.0011.56 (1.34-1.80) p<0.0011.59 (1.16-2.18) p=0.0041.76 (1.35-2.29) p<0.0011.67 (1.43-1.94) p<0.001 Conclusion: OS in women with de novo stage IV BC in AB was similar to US insured. AB and US insured experienced superior OS compared with US Medicaid and uninsured. Citation Format: Kornaga EN, Matutino AR, Pereira AA, Verma S, Lupichuk S. Survival in women with de novo metastatic breast cancer: Comparison of real-world evidence from publicly-funded Canadian province and the United States by insurance status [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-13.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».