Abstract 4365249: Treatment Modality and Cardiovascular Mortality in Breast Cancer: A SEER and Single-Center Analysis by Stage and Receptor Subtype
Bibliographic record
Abstract
Background: CV mortality (CVM) is a critical competing risk in breast cancer (BC). How therapy type affects CVM by stage and receptor subtype remains incompletely defined. Objective: Compare CVM risk across treatment modalities: chemotherapy alone (C), radiotherapy alone (R), or both (C + R), in BC stages I–IV (2010–2015), stratified by receptor subtype (Luminal A (LA), Luminal B (LB), Her2-enriched, triple negative BC (TNBC)). Methods: Among 282,991 SEER patients (2010–2015), multivariable Cox models (adjusted for age, race, and laterality) and stratified by stage and receptor status estimated adjusted hazard ratios (AHRs) for CVM: C vs R and C + R vs R. Receptor-specific temporal CVM trends are shown in Figure 1. To account for baseline CV comorbidity, 1555 patients from Georgia Cancer Center (2010–2015) were analyzed, adjusting for age, receptor status, stage, hypertension, diabetes, and hyperlipidemia. Results: For the SEER cohort, there was an overall downward trend of CVm across stages 1, 2, and 3. In stage II breast cancer, both LA and LB subtypes showed significant reductions in cardiovascular mortality with C or C + R compared to R. For LA, the AHR was 0.75 (95% CI: 0.59–0.95) for C vs R and 0.75 (95% CI: 0.61–0.93) for C + R vs R. For LB, AHRs were 0.54 (95% CI: 0.33–0.90) for C vs R and 0.44 (95% CI: 0.27–0.74) for C + R vs R. In stage III disease, patients with LA who received C + R had a significantly lower risk (AHR 0.49, 95% CI: 0.35–0.68), as did those with TNBC receiving C + R (AHR 0.33, 95% CI: 0.13–0.82). There were no significant associations for other stage-receptor subgroups (p > 0.05). In the Georgia cohort, neither C nor C + R was associated with lower cardiovascular mortality compared to R (p > 0.05). Conclusions: In stages I–III, Patients selected to receive C (± R) has lower CVM vs R alone in LA (stage II–III), LB (stage II), and TNBC (stage III). CVM did not decline in stage IV (AHR ~1.0), possibly due to expanding use of newer systemic therapies. Temporal trend analysis (Figure 1) suggests broader improvements in CV risk management perhaps due to improvement of cardiac care of BC patients; aligning FDA approval timelines with CVM in BC may further elucidate therapy-related CV risks.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".