Associations between axillary staging, adjuvant treatment, and survival in older women with early-stage breast cancer: A population-based study.
Notice bibliographique
Résumé
577 Background: The Choosing Wisely guidelines recommend against surgical axillary staging (AS) in women ≥70 years with ER+/HER2- early stage breast cancer (BC). However, there has been little change in practice patterns, which may be influenced by observational studies reporting worse survival among women not receiving AS. Previous analyses did not take into account comorbidities, specific adjuvant treatments and HER2 status which may confound the association between AS omission and survival. This study examined the impact of AS omission on survival in older patients with Stage I/II BC, and secondarily emulated the Choosing Wisely population in a subgroup of those ≥70 years undergoing sentinel node biopsy (SLNB) vs. no AS for ER+/HER2- tumors. Methods: This was a population-based cohort study using linked health administrative data in Ontario, Canada. From the Ontario Cancer Registry, we identified women aged 65-95 years who underwent surgery for Stage I/II BC between 2010 and 2016. We excluded women who received neoadjuvant chemotherapy. To address confounding between those who did and did not receive AS, we built a propensity score model including patient and disease characteristics. Patients were weighted by propensity scores using overlap weights. Association with overall survival (OS) was calculated using weighted Cox proportional hazards models, and breast cancer-specific survival (BCSS) was calculated using weighted Fine and Gray models, adjusting for biomarkers and adjuvant treatments. Adjuvant treatment receipt was modelled with weighted log-binomial models. Results: Among 17,546 older women, 1,807 (10.3%) did not undergo AS, who were older, more comorbid, less likely to undergo mastectomy, and more likely to have tumors ≥ 2 cm. After propensity score weighting, baseline characteristics including comorbidity were balanced between the two groups. Women who did not undergo AS were less likely to receive adjuvant chemotherapy (adjusted RR 0.70. 95% CI 0.58-0.84), endocrine therapy (adjusted RR 0.85, 95% CI 0.82-0.89) and radiotherapy (adjusted RR 0.69, 95% CI 0.65-0.73). Unadjusted 5-year survival was lower for women who did not undergo AS (68.1%, 95% CI 65.8-70.2 vs. 87.6%, 95% CI 87.0-88.1; p< 0.001), and there was a higher 5-year incidence of BC deaths (7.6%, 95% CI 6.2-9.2 vs. 4.3%, 95% CI 3.9-4.7; p< 0.001). After weighting and adjustment, women who did not undergo AS continued to have worse OS (adjusted HR 1.13, 95% CI 1.03-1.24), however, there was no significant difference in BCSS (adjusted HR 1.00, 95% CI 0.78-1.26). The results among 6,286 ER+/HER2- women ≥70 years undergoing SLNB vs. no AS were similar for OS (adjusted HR 1.22, 95% CI 1.05-1.42) and BCSS (adjusted HR 1.08, 95% CI 0.67-1.76). Conclusions: The omission of AS in older women with early stage BC was associated with worse OS, reflecting selection bias, but no significant difference in BCSS.
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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 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».