JAMA Oncol: The relationship between chemotherapy and survival in elderly breast cancer patients with multiple complications combined with ER-N-plus.

The risk and incidence of breast cancer increases with age, and the treatment of older patients with significant complications faces challenges.
efforts to provide comprehensive treatment for these patients while minimizing the impact on quality of life and avoiding damage to the functional state of patients with already limited life expectancy.
Recently, JAMA Oncology published a retrospective study using data from the National Cancer Database (NCDB) to study the relationship between complementary chemotherapy and survival in older patients who were positive for breast and armpit surgery, and those with pathological lymph node-positive leaching breast cancer combined with multiple complications, providing a new basis for treatment decisions in patients with multiple complications combined with old age breast cancer.
personalized exploration of breast cancer risk and complications increased with age in patients with combined complications of advanced breast cancer, and the relationship between complementary chemotherapy and survival rates was lacking in older breast cancer patients with positive lymph nodes combined with multiple complications.
retrospective study of four randomized clinical trials of lymph node-positive female breast cancer showed that older or younger patients who received intense chemotherapy programs reduced both breast cancer mortality and recurrence rates.
but in this study, only 2 percent of patients were 70 years old, and the authors caution against applying these findings to older patients.
current NCCN guidelines for breast cancer in older patients: For women aged 70 ... There is not enough data to make clear chemotherapy recommendations... For patients of this age, complications should be considered for individualized treatment.
lack of data on survival benefits associated with complementary chemotherapy because older patients with multiple combinations are often excluded from clinical trials.
Given the ageing population and the lack of standardized treatments for older breast cancer patients, it is important to study the relationship between cancer treatment and survival in this group of people, and the purpose of this study is to study the relationship between complementary chemotherapy and survival in older patients with estrogen-positive, pathologically lymph node-positive leaching breast cancer combined with multiple combinations.
retrospective cohort study used data from the National Cancer Database (NCDB), a joint project of the American College of Surgeons and the American Cancer Society's Cancer Council, from January 1, 2010 to December 31, 2014, screening from the NCDB database for breast milk. Gland and armpit surgery, estrogen-positive and HER2-negative, phased in patients with pT1-4/pN1-3 immersive breast cancer, patients with a 2 or 3 score for Nacharson/Deyo complications, excluding patients with a Charlson/Deyo complication score of 1 or 0.
Charlson/Deyo score is a weighted score from the sum of the scores for complications.
, for example, patients with a score of 2 may include chronic lung disease and congestive heart failure.
current study, patients with a score of 2 or 3 were considered to have serious complications that required medical management, affected overall health, and may affect life expectancy.
included the NCDB-defined race/ethnicity in the analysis to make the results more widely possible for the U.S. population.
if a patient is diagnosed with stage M1 disease, they are excluded.
Patients who have underwent new complementary therapies (chemotherapy, radiotherapy or endocrine therapy);
hormone-positive patients with missing hormone-like status and HER2-positive were excluded.
Data Analysis: In order to reduce the effect of bias on treatment and total survival of observational study data treatment options, the researchers conducted a tendency score matching analysis in which the following covariates were included in the multiple logistic regression models to create a tendential score: age at diagnosis, Charlson/Deyo score (2 or 3), body status, geographic location (large city, city, rural or unknown), pathological T-phase, pathological N-phased, endocrine therapy.
elderly breast cancer patients with multiple complications, 2445,870 patients in the database associated with complementary chemotherapy and OS improvement, 1592 patients met the group criteria (average age 77.5 years; 1543 (96.9 percent) women) were included in the initial mismatch analysis.
350 (22.0%) received chemotherapy and 1,242 (78.0%) did not.
Patients who received chemotherapy were younger (with a medium age of 74 years and a comparison age of 78) and had a higher disease classification (3 levels: 116 (33.1 per cent) vs 302 (24.3 per cent); P s 0.002), larger primary tumors (tumors phased at pT3/T4: 72 s 20.6%) chemotherapy group compared to 182 s 14.7% non-chemotherapy group, P s 0.005), higher lymph node load (tumor division) The phase pN3 was 75 (21.4 percent) compared to the non-chemotherapy group 81 (6.5 percent) and the tumor phased pN1 chemotherapy group was 182 (52.0 percent) compared to the non-chemotherapy group 936 (75.4 percent).
patients who received chemotherapy received radiotherapy (236 (67.4 percent) compared to 540 (43.5 percent) than those who did not receive chemotherapy; There was no difference between the type of initial mastectomy (a lumpectomy or mastectomy) between patients with chemotherapy and non-chemotherapy , compared to 1025 (88.3 per cent) and endocrine therapy (309 .88.3 per cent) and P . . . 0.01, and most of the patients in both groups had a mastectomy.
results: In non-matching queues, the middle follow-up was 41.4 months (95% CI, 39.7-43.7 months), and the group's mid-OS was 59.5 months (95% CI, 55.0-0) 65.6 months): Patients receiving chemotherapy had OS for 78.9 months (95% CI, 68.2 months to reach) and patients without chemotherapy had OS for 54.9 months (95% CI, 51.3-58.0 months).
Tendency Score Match Analysis and Results: A total of 592 patients were included in the matching analysis, with an absolute standard deviation of less than 10.25% for all variables between the two groups, (Table 1) representing better matching, with the middle follow-up of 43.1 months (95% CI:39.6 to 46.1) in the matching queue 5 months; the difference between the medium OS in the chemotherapy group was 78.9 months (95% CI, 78.9 months to reach), and the non-chemotherapy group was 62.7 months (95% CI, 56.2 months to not reached), and the difference between the two was not statistically significant (P-0.13).
multi-factor analysis: After adjusting other risk factors in the matching queue, the chemotherapy group benefited from OS compared to the non-chemotherapy group, with a risk ratio of 3 points compared to HR-0.67; (95% CI, 0.48-0.93; P-0.02), and a 3-point comparison with the poor prognosmodes in the matching queue (HR, 1.94; 95% CI, 1.34-2.79; P.lt;0.001), higher pathological T-phase (pT4 vs pT1: HR, 3.51; 95% CI, 1.86-6.62; P.lt;0.001), higher pathology N phase (pN3 vs pN1:HR, 1.71; 95% CI, 1.09-2.69; P -0.04).
factors associated with OS prognosmation improvement in the matching queue were endocrine therapy (HR, 0.47; 95% CI, 0.31-0.72; P-lt;0.001) and radiotherapy (HR, 0.61; 95% CI, 0.43-0.87; P-0.06).
age is associated with an increased incidence of complications and an increased risk of breast cancer, and while management decisions should not be based on age alone, NCCN guidelines recommend that complications should be taken into account in the treatment of breast cancer patients over the age of 70.
However, this population is usually excluded from clinical trials, and there is little data on the correlation between treatment and survival rates in older patients with multiple complications, with 22.0% of patients receiving chemotherapy in this contemporary analysis of estrogen-positive, pathologically lymph node-positive breast cancer patients in older patients.
we know, this is the first retrospective study to evaluate the results of complementary chemotherapy in patients with combined complications of breast cancer in old age.
we only assessed patients who were estrogen-positive and pathologically positive for lymph nodes, and we found that patients who received chemotherapy were younger, had higher lymph nodes, and had higher stages of the disease.
study of elderly breast cancer patients who were positive for estrogen-positive, pathological lymph nodes combined with multiple complications found that receiving complementary chemotherapy was associated with OS improvement.
patients who received chemotherapy were younger and more likely to receive other complementary treatments, suggesting that despite multiple combinations, doctors could carefully select patients who might benefit from complementary chemotherapy based on certain unde measured variables.
, estrogen-positive breast cancer is a heterogeneic disease, and the survival benefits of chemotherapy may be related to differences in the Luminal subtype.
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