Background A systematic review and meta-analysis was conducted to assess breast cancer (BC) outcomes among patients with early-stage hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) BC, receiving adjuvant endocrine therapy. Methods Randomized controlled trials (RCTs) and real-world evidence (RWE) studies were identified using Ovid MEDLINE®, Embase, and Evidence-Based Medicine Reviews. Clinical and methodological similarities including alignment of outcome definitions with standardized definitions for efficacy endpoints criteria were assessed to evaluate feasibility of conducting a meta-analysis. Where feasible, 5-year probabilities of BC recurrence or death were estimated using a Bayesian hierarchical arm-based model. Results Of 21 included studies, 8 RCTs and 4 RWE studies reported outcome data of interest. There was heterogeneity in outcome reporting, as well as variation in recurrence risk amongst studies with aligned reporting. Of the 12 studies, 10 were considered for inclusion in a meta-analysis of BC recurrence or death. Only a subgroup analysis of node-positive patients (3 studies; n = 7307) was deemed feasible. The 5-year probability of BC recurrence or death was 17.2% (95% credible interval: 14.6%–20.3%). Conclusion Although studies reporting recurrence outcomes were limited, there remains a high risk of BC recurrence, especially among node-positive patients. Approximately 1 in 6 women with node-positive HR+/HER2- early-stage BC receiving endocrine therapy experience recurrence or death within 5-years of initiating treatment, suggesting a need for novel treatments for this population.
THE ROUTINE 12 lead electrocardiogram is not always reliable in demonstrating right ventricular hypertrophy (RVH), this is particularly true in patients with acquired valvular disease, or with mild or moderate RVH.'12 Such discrepancies are understandable when one considers that the most commonly used criteria for RVH are based on voltages,3-5 and that only in cases of severe or massive RVH can the electromotive forces generated in the right ventricle (RV) counterbalance those produced in the left ventricle (LV). 1 2 Our experience as well as that of several others-9 has demonstrated the usefulness and merits of the orthogonal vectorcardiogram. Furthermore, Toshima et al.'0 using the Schmitt-Simonson system (SVEC III) in patients with mitral and aortic valvular disease and left ventricular hypertrophy (LVH) not only were able to evaluate the hypertrophy more accurately but also in most cases were able to make a correct diagnosis of the specific valvular lesion causing it.Mitral stenosis is known to produce pulmonary venous obstruction, left atrial enlargement, pulmonary hypertension, and ultimately RVH. The purpose of this paper is to report the vectorcardiographic findings, with use of From the
Background: Multiple independent risk factors are associated with the prognosis of hormone receptorpositive (HRþ), human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC), the most common BC subtype. This study describes U.S. population-based recurrence rates among older, resected women with HRþ/HER2-early BC. Methods: We conducted a retrospective cohort study of older women diagnosed with incident, invasive stages I-III HRþ/HER2-BC who underwent surgery to remove the primary tumor using the Surveillance, Epidemiology, and End Results (SEER)-Medicare Linked Database (2007e2015). SEER records and administrative health claims data were used to ascertain patient and tumor-specific characteristics, treatment, and frailty status. Cumulative incidences of BC recurrence were estimated using a validated algorithm for administrative claims data. Multivariable Fine-Gray competing risk models estimated adjusted subdistribution hazards ratios and 95 % confidence intervals for associations with BC recurrence risk. Results: Overall, 46,027 women age 65 years were included in our analysis. Over a median follow up of 7 years, 6531 women experienced BC recurrence with an estimated 3 and 5-year cumulative incidence rates of 10 % and 16 %, respectively. Higher 3-and 5-year cumulative incidences were observed in women with larger tumor size (5þ cm, 21 % and 28 %), lymph node involvement (4þ nodes, 27 % and 37 %), and with frail health status at diagnosis (13 % and 20 %). Independent of these clinical risk factors, Black, Hispanic and American Indian/Alaskan Native women had significantly increased BC recurrence risks. Conclusions: Rates of recurrence in HRþ/HER2-early BC differs by several patient and clinical factors, including high-risk tumor characteristics. Racial differences in BC outcomes deserve continued attention from clinicians and policymakers.
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