Long-term survival and stage I breast cancer subtypes

Cheng, Skye Hung-Chun; Yu, Ben-Long; Horng, Cheng-Fang; Tsai, Shih Chang; Chen, Chii‐Ming; Chu, Nai‐Shin; Tsou, Mei-Hua; Lin, C.; Shih, Li-Wen; Liu, Mei-Ching

doi:10.1016/j.jcrpr.2015.10.005

Cited by 15 publications

(14 citation statements)

References 18 publications

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“… 15 Few studies have suggested that the effect of age on outcome may vary by tumor subtype. 15 , 26 – 28 As in other studies, 24 , 29 Luminal A was the most common subtype in both the age groups ( Table 5 ). However, older patients had a larger percentage of Luminal A subtype than younger patients.…”

Section: Discussionsupporting

confidence: 73%

Younger age is an independent predictor of worse prognosis among Lebanese nonmetastatic breast cancer patients: analysis of a prospective cohort

Chediak¹,

Alameddine²,

Hakim³

et al. 2017

BCTT

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BackgroundSeveral retrospective studies have reported that younger age at presentation is associated with a worse prognosis for nonmetastatic breast cancer patients. In this study, we prospectively assessed the association between different baseline characteristics (age, tumor characteristics, mode of treatment, etc) and outcomes among newly diagnosed nonmetastatic Lebanese breast cancer patients.MethodsWe recruited a sample of 123 women newly diagnosed with nonmetastatic breast cancer presenting to American University of Beirut Medical Center. Immunohistochemical, molecular (vitamin D receptor, methylene tetrahydrofolate reductase polymorphisms), and genetic assays were performed. Patient characteristics were compared by age group (<40 and ≥40 years). A Cox regression analysis was performed to evaluate the variables affecting the disease-free survival (DFS). Outcome data were obtained, and DFS was estimated.ResultsAmong the 123 patients, 47 were 40 years of age or younger, and 76 were older than 40 years. Median follow-up duration was 58 months. Nine out of 47 patients <40 years (19.1%) experienced disease relapse in contrast to four out of 76 patients >40 years (5.2%). A wide immunohistochemical panel included Ki-67, cyclin B1, p53, platelet-derived growth factor receptor, and vascular endothelial growth factor receptor, and did not reveal any significant difference in these markers between the two age groups. Older patients had a larger percentage of Luminal A than younger patients. On multivariate analysis including age, stage, grade, and subtype, only age <40 and stage were significantly associated with shorter DFS with hazard ratios of 4 (p=0.03, 95% confidence interval [CI]: 1.1–13.5) and 3 (p=0.03, 95% CI: 0.8–14.9), respectively. The estimated 5-year DFS for patients >40 years was 90%, and for patients <40 years was 37%.ConclusionBeing <40 years old was an independent risk factor for recurrence in this cohort of patients.

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Section: Discussionsupporting

confidence: 73%

Younger age is an independent predictor of worse prognosis among Lebanese nonmetastatic breast cancer patients: analysis of a prospective cohort

Chediak¹,

Alameddine²,

Hakim³

et al. 2017

BCTT

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“…Early-stage patients with the luminal-like subtypes of breast cancer are commonly overtreated with adjuvant chemotherapy [ 14 ]. To overcome this issue, genomic assays, including ODx, have been utilized to predict the recurrence risk of early-stage breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have suggested that luminal-like cancers tend to have the most favorable prognosis and longer-term survival when compared with the other subtypes [ 11 , 12 ]. However, early-stage breast cancer patients with the luminal-like subtypes are commonly (up to 75%) overtreated with adjuvant chemotherapy despite that recent studies have indicated that adjuvant chemotherapy may not provide significant benefit in reducing risk of recurrence [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Gene expression profiling in prognosis of distant recurrence in HR-positive and HER2-negative breast cancer patients

et al. 2018

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There had been several studies using gene-expression profiling in predicting distant recurrence in breast cancer. In this study, we developed an 18-gene classifier (18-GC) to predict distant recurrence of breast cancer and compared it with the 21-gene panel (Oncotype DX®, ODx) in performance. Included were 224 breast cancer patients with positive hormonal receptor (HR+) and negative human epidermal growth factor receptor 2 (HER2-). We compared the demographic, clinical, and survival information of the patients, and further compared the prediction of recurrence risk obtained by using the 18-GC with that by ODx. To have the best combined sensitivity and specificity, receiver operating characteristics (ROC) curve analysis was performed to determine the cutoff values for several breakpoint scores. For the new 18-GC, a breakpoint score of 21 was adopted to produce a combined highest sensitivity (95%) and specificity (39%) in detecting distant recurrence. At this breakpoint score, 164 of the 224 patients were classified by the 18-GC in the same risk level as by ODx, giving a concordance rate of 73%. Along with patient age and tumor stage, this 18-GC was found to be an independent significant prognostic factor of distant metastasis of breast cancer. We have thus created a new gene panel assay for prediction of distant recurrence in HR+ and HER2- breast cancer patients. With a high concordance rate with ODx, this new assay may serve as a good tool for individual breast cancer patients to make an informed decision on whether adjuvant chemotherapy should be performed post-surgery.

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“… 3 Patients may suffer from the side effects of anticancer regimens (ovarian failure, cardiotoxicity, nausea, hair loss, hematological malignancies) without receiving the full benefit of adjuvant therapies, and in the most severe cases, may die from the side effects of medications. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis from a Societal Perspective of Recurrence Index for Distant Recurrence (RecurIndex) in Women with Hormone Receptor-Positive and HER2-Negative Early-Stage Breast Cancer

Pennarun¹,

JY²,

HC³

et al. 2022

CMAR

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Purpose A clinical-genomic prognostic multigene panel (RI-DR assay, RecurIndex ® ), predicting the risk level of distant recurrence (DR) in early-stage breast cancer (EBC) patients with an Asian background, has been validated as a valuable tool for identifying high-risk patients to develop distant recurrence (metastasis). Although the clinical benefit of adjuvant chemotherapy from the assay’s prediction is already proved, its affordability remains uncertain. This study is the first time in which the long-term cost-effectiveness of the RI-DR assay is evaluated. Patients and Methods A lifetime Markov decision-analytic model was developed from a societal perspective to estimate the life-years gained (LYGs), quality-adjusted life-years (QALYs), medical costs, and incremental cost-effectiveness ratios (ICERs), comparing EBC women with and without RI-DR genomic testing. A decision tree was used to classify patients in one of the fifteen end nodes (by order, each arm was stratified by a patient being tested or not with the RI-DR assay, being treated or not with adjuvant chemotherapy and had no, minor, major, or fatal toxicity after adjuvant chemotherapy). Health utilities, costs, transition probabilities, and survival data were extracted from the scientific literature. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed on variables to assess the robustness of the model. A willingness-to-pay (WTP) threshold of 790,000 NT$ per QALY gained was considered as a cost-effectiveness criterion. Results The incremental cost per QALY gained under base-case assumptions of the model was 173,842 NT$. Findings on the variation in model input parameters were robust and confirmed that every key variable was cost-effective for the benefit of RI-DR testing. Conclusion The clinical-genomic RI-DR assay is cost-effective in guiding adjuvant chemotherapy decisions compared to current clinical practice guidelines.

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Long-term survival and stage I breast cancer subtypes

Cited by 15 publications

References 18 publications

Younger age is an independent predictor of worse prognosis among Lebanese nonmetastatic breast cancer patients: analysis of a prospective cohort

Younger age is an independent predictor of worse prognosis among Lebanese nonmetastatic breast cancer patients: analysis of a prospective cohort

Gene expression profiling in prognosis of distant recurrence in HR-positive and HER2-negative breast cancer patients

Cost-Effectiveness Analysis from a Societal Perspective of Recurrence Index for Distant Recurrence (RecurIndex) in Women with Hormone Receptor-Positive and HER2-Negative Early-Stage Breast Cancer

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