Evaluating and Balancing the Risk of Breast Cancer-Specific Death and Other Cause-Specific Death in Elderly Breast Cancer Patients

Abstract

Purpose: The dilemma of undertreatment and overtreatment of elderly breast cancer patients is common. This study aimed to investigate clinicopathological features, treatment modalities, and survival in women diagnosed with breast cancer at age 70 years or over, and to assist clinicians in developing individualized treatment plans by balancing the risks of breast cancer-specific death (BCSD) and other cause-specific death (OCSD).Methods: This retrospective study included 420 women who were diagnosed with pathologically confirmed invasive breast cancer at age 70 years or older from January 2008 to December 2015 at Peking University People's Hospital (PKUPH). We collected baseline health status, tumor characteristics, treatment choices, and outcomes and created nomograms for clinicians to estimate individualized BCSD and OCSD risk directly.Results: During a median follow-up of 71.5 months (range 2 to 144 months) in patients with stage I–III tumors, breast cancer specific survival (BCSS) was 92.4% (376/407) and overall survival (OS) was 78.1% (318/407). There were 89 deaths, and 65.2% (58/89) were non-breast cancer related. Upon multivariate analysis by Cox regression model, tumor size, positive lymph nodes, Ki-67, and surgery were independent predictors of BCSS, and comorbidities, positive lymph nodes, Ki-67, surgery, and endocrine therapy were independent predictors of OS. Propensity score weighted (PSW) was applied to analyze therapeutic efficacy, and there was BCSS and OS benefit with surgery (both p < 0.001), BCSS benefit with chemotherapy (p = 0.029), BCSS and OS benefit with endocrine therapy (p = 0.006 and 0.004), and neither BCSS nor OS benefit with radiotherapy (RT) (p = 0.348 and 0.289). Competing-risk nomograms were developed to estimate cumulative mortality probabilities for BCSD and OCSD for individual patients according to clinicopathologic characteristics and treatments. The calibration curves displayed exceptionally, with C-indexes 0.714 for BCSD and 0.717 for OCSD.Conclusions: Older patients had greater risk of dying from non-breast cancer causes. Surgery, chemotherapy, and endocrine therapy were associated with improved survival. Competing risk nomograms allowed individual assessment of BCSD and OCSD, based on clinicopathological characteristics and treatment options, and can be used as a tool to help in choosing appropriate treatment strategies.This study was approved by the Peking University People's Hospital Research Ethics Board on September 4, 2018.

Effect of adjuvant chemotherapy on the survival outcomes of elderly breast cancer: A retrospective cohort study based on SEER database

“…In the subgroup analysis, no interaction was observed in age groups, which is in line with the findings of Sharon H et al 24 However, one study 21 found that compared with young patients, those older than 70 years enjoyed limited benefits. A retrospective study for patients older than 70 years 34 36 For those with triple-negative breast cancer, adjuvant chemotherapy played a particularly important role in their survival due to the lack of benefits from endocrine therapy and targeted therapy.…”

“… 24 However, one study 21 found that compared with young patients, those older than 70 years enjoyed limited benefits. A retrospective study for patients older than 70 years 34 found an interaction between the effect of chemotherapy and age after PS, with the OS benefit observed only in the subgroup aged 70−75 years instead of the older subgroups or any subgroups in BSCC. However, only 420 patients were included in this study.…”

Prediction model of all-cause death based on balance ability among middle-aged and older Chinese adults of overweight and obesity

“…The results were analyzed by C-index, calibration curve, and Hosmer-Lemeshow test. Studies have proved the feasibility and importance of nomograms in predicting all-cause deaths ( 16 ). In our study, a nomogram of all-cause mortality in Chinese adults 45 years of age and older with overweight and obesity was established based on the risk factors obtained by Cox regression analysis.…”

Establishment and validation of a nomogram for predicting immune-related prognostic features in trunk melanoma-specific death

“…carcinoma, maxillary sinus carcinoma, and breast cancer in the elderly (21)(22)(23). Although some studies have mentioned melanoma, no specific studies have been conducted on trunk melanoma due to its small sample size, single source of sample size, or lack of CSD risk factor assessment.…”

“…Factors incorporated into such nomograms have included sex, age, date of diagnosis, date of sentinel lymph node biopsy (SLNB), characteristics of the primary tumor (Breslow thickness, ulceration), recurrence and follow-up details, race, marital status, insurance, AJCC stage T and N, number of metastatic organs, surgical treatment, and chemotherapy ( 19 , 20 ). Recently, many studies have also documented the prognosis of other tumors, such as parotid carcinoma, maxillary sinus carcinoma, and breast cancer in the elderly ( 21 - 23 ). Although some studies have mentioned melanoma, no specific studies have been conducted on trunk melanoma due to its small sample size, single source of sample size, or lack of CSD risk factor assessment.…”