Abstract PS1-06: High-risk breast cancer in oldest old: Exploring the effect of different treatments on outcomes
Notice bibliographique
Résumé
Abstract Background: Octogenarians and nonagenarians diagnosed with breast cancer have a competing risk of death from other causes and their management is frequently found to be discordant with guidelines in comparison to the younger patients, particularly with low-risk disease. There is limited information about the disease trajectory and outcomes of patients with high-risk disease. Thus, this study was conducted. Methods: This is a retrospective, population-based observational study. Women aged 80 years of age or older and diagnosed with non-metastatic, high-risk breast cancer in Alberta, Canada between January 2004 and December 2017 were identified from the Alberta Cancer Registry. High-risk disease was defined as having any of the following; T3/4, any N positive, triple negative, or Her-2 positive disease. A risk scoring system was generated based on the presence of two anatomical and one biological high-risk features to generate 3 risk levels. Patients’ characteristics (age, Charlson comorbidity index, residence, education-, and income- quintiles), disease characteristics (stage, grade, receptor status,) treatment patterns (treatment delivered, facility) and survival were determined from linkage with administrative databases (Discharge Abstract Data, National Ambulatory Care Reporting System, and Vital statistics). Treatments were stratified into; none, hormonal treatment only (HT), surgery only (S), and surgery with any adjuvant treatment (S+A). Statistical methods included chi-square and Cox regression models. Association between patient, tumor and treatment variables and survival were assessed with uni- and multivariable analysis. Primary outcome was breast cancer specific survival (BCSS) in patients stratified by different risk levels in relation to the treatment delivered. Results: 1369 patients met the inclusion criteria. The median age was 84 years (interquartile range [IQR] 82-88). After a median follow-up of 35 months (m), 873 (64%) patients had died; 405 (46%) of deaths were due to breast cancer. On multivariable analysis, patients had a lower hazard of death from cancer if they were treated with S (HR = 0.51, 95%CI: 0.34, 0.77, p = 0.001) or S+A (HR = 0.41, 95%CI: 0.28, 0.6, p < 0.001) in comparison to HT alone. Patients who did not receive any form of treatment were more likely to die from breast cancer (HR 2.14 95%CI: 1.38, 3.31, p = 0.0006). Patients who had 1 or 2 risk features had higher cancer specific and overall survival if they had S or S+A (49/31m, 92/66m median differences respectively p < .0001). Those with 3 risk features showed longer survival if they received S+A (29/25m median differences p < .0001). Conclusions and Relevance: Our findings suggest that a significant proportion of older patients with breast cancer patients with high-risk features may have increased disease-specific mortality risk. Based on a priori risk levels, and in properly selected patients, treatment options including surgery and adjuvant treatment may be associated in longer survival. Table 1 - Population and Treatment CharacteristicsVariablesCategoryTotal (N=1369)Age group80-85817 (59.7 %)86-90388 (28.3 %)91-95146 (10.7 %)>9518 (1.3 %)Charlson Comorbidity Index0453 (33.1 %)1361 (26.4 %)>=2555 (40.5 %)TNM stageI239 (17.5 %)II663 (48.4 %)III422 (30.8 %)T stageT1416 (30.4 %)T2601 (43.9 %)T3163 (11.9 %)T4169 (12.3 %)Unknown20 (1.5 %)N stageN0526 (38.4 %)N1548 (40 %)N2159 (11.6 %)N385 (6.2 %)Unknown51 (3.7 %)Receptor statusER+orPR+andHer2-1071 (78.2 %)Her2+130 (9.5 %)ER-andPR-andHer2-123 (9 %)Unknown45 (3.3 %)Risk levels1922 (67.3 %)2371 (27.1 %)376 (5.6 %)Surgery typeNo surgery215 (15.7 %)BCS364 (26.6 %)Mastectomy790 (57.7 %)Sentinel surgeryno938 (68.5 %)yes431 (31.5 %)Chemotherapyno1337 (97.7 %)yes32 (2.3 %)Radiotherapyno991 (72.4 %)yes378 (27.6 %)Hormonotherapyno659 (48.1 %)yes710 (51.9 %) Citation Format: Abdulla Al-Rashdan, Yuan Xu, Lisa Barbera, Jeffrey Cao, Winson Cheung, Antoine Bouchard-Fortier, MayLynn Quan. High-risk breast cancer in oldest old: Exploring the effect of different treatments on outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-06.
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 | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 ».