Archives

  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2020-03
  • 2020-07
  • 2020-08
  • 2021-03
  • Size cm br b REF br REF br

    2019-09-16

    Size, cm
    b2 REF
    REF
    Grade
    REF
    Stage
    I REF
    REF
    Bold text designates statistical significance.
    Table 3
    Cox proportional hazard model for factors associated with survival among patients who underwent Recurrence Score (RS) testing.
    Patients aged 70 years and older
    Hazard Ratio 95% Hazard Ratio P-Value
    Hazard Ratio 95% Hazard Ratio P-Value
    Confidence Limits
    Confidence Limits
    Age, years
    NA
    NA
    NA
    REF
    Race
    Non-Hispanic White REF
    REF
    Year of Diagnosis
    REF
    Progesterone Receptor Status
    Positive REF
    REF
    Lymph Node Status
    Negative REF
    REF
    Size, cm
    b2 REF
    REF
    Grade
    REF
    Stage
    I REF
    REF
    Chemotherapy
    No/Unknown REF
    REF
    TAILORx RS Risk Group
    REF
    Bold text designates statistical significance.
    were stratified by treatment with or without chemotherapy. In the young cohort, chemotherapy was associated with a significant improve-ment in overall survival (p = .004). There was no significant difference in overall survival with the use of chemotherapy in the older cohort (p = .60). Breast cancer-specific survival for patients with high-risk RS demonstrated similar findings (Fig. 3).
    Cox proportional hazard models were performed in high-risk pa-tients in the young and older cohorts (Table 4). In the young cohort, fac-tors associated with an increased HR of death among high-risk TAILORx patients were older age (60–69 years compared to 18–49 years), PR negative status, and higher tumor stage (stage II and stage III as com-pared to I). The only factor associated with a decreased hazard ratio of death in high-risk patients was receipt of chemotherapy.
    Among high-risk patients in the older cohort, the only factor associ-ated with an increased HR of death was older age (≥80 years compared to 70–79 years). We found a decreased hazard of death for Asian and other Pifithrin-α (PFTα) when compared to non-Hispanic white. The use of chemo-therapy was not associated with a lower hazard ratio of death in older high-risk patients.
    4. Discussion
    In species diversity study of older women with ER-positive breast cancer, we found decreased rates of RS utilization when compared to a young co-hort. However, when tested, older patients have a similar distribution of high-, intermediate-, and low-risk RS compared to younger patients. In patients 70 years and older, factors associated with an increased odds of RS testing include later year of diagnosis and stage II disease. Factors 
    associated with decreased odds of RS testing include increased age, black or Asian race, negative PR status, positive LN status, increasing tumor size, grade III tumors, and stage III disease. Chemotherapy use was more frequent among older patients with high-risk RS as compared with low- and intermediate-risk RS. High-risk RS categorization was as-sociated with increased mortality for both young and older patients. In patients aged 18–69 years with a high-risk RS, chemotherapy use was associated with an expected lower HR of death. However, in patients aged 70 years or older with high-risk RS, no survival benefit was ob-served with the use of chemotherapy.
    Older patients with breast cancer represent a unique cohort and re-quire special consideration when determining management. A greater percentage of older women develop ER-positive breast cancer when compared to younger women [17]. Older patients also have a lower per-centage of HER2-positive tumors [18]. RS testing is indicated in patients with ER-positive and HER2-negative breast cancer, therefore, the assay can be considered in many older patients with a new diagnosis of breast cancer. In the present study, we found that a lower percentage of pa-tients in the older cohort underwent RS testing when compared to a young cohort. However, the use of RS testing significantly increased among older patients during our study period. A similar percentage of patients undergoing testing was found in previous evaluations of RS test-ing in a study of the Centers for Medicare and Medicaid Services database [15]. The decreased use of RS testing in older patients, as compared with younger patients, may represent an inclination towards decreased che-motherapy use. Given the increased burden of comorbidities in older women, patient frailty would limit the use of chemotherapy regardless of risk stratification, thus precluding the need for RS testing.