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The Prognostic Impact of Age at Diagnosis Upon Breast Cancer of Different Immunohistochemical Subtypes: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Analysis

ABSTRACT: Background and Objectives: The influence of age at diagnosis of breast cancer upon the prognosis of patients with different immunohistochemical (IHC)-defined subtypes is still incompletely defined. Our study aimed at examining the association of age at diagnosis and risk of breast cancer-specific mortality (BCSM). Methods: 172,179 eligible breast cancer patients were obtained for our study cohort using the Surveillance, Epidemiology, and End Results database from 2010 to 2015. Patients were classified into four IHC-defined subtypes according to their ER, PgR, and HER2 status. Kaplan–Meier plots were used to describe BCSM among patients in different age groups. A Cox proportional hazards model was used for multivariate analysis. A multivariable fractional polynomial model within the Cox proportional hazards model was used to evaluate the relationship between age at diagnosis and the risk of BCSM. Results: For the whole cohort, the median follow-up time was 43 months. Patients younger than 40 years and those older than 79 years presented with the worst BCSM (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.03–1.23, and HR 3.52, 95% CI 3.23–3.83, respectively, p < 0.01, with age 40–49 years as the reference). The log hazard ratios of hormone receptor (HoR)(+)/HER2(–) patients formed a quadratic relationship between age at diagnosis and BCSM, but not in the other three subtypes of breast cancer. In the HoR(+)/HER2(–) subtype, patients younger than 40 years had worse BCSM than those aged at 40–49 years (HR 1.26, 95% CI 1.10–1.45, and p < 0.01). Conclusions: Women diagnosed with HoR(+)/HER2(–) breast cancer younger than 40 years or older than 79 years of age suffer higher rates of cancer-specific mortality. Young age at diagnosis may be particularly prognostic in HoR(+)/HER2(–) breast cancer.

SUBMITTER: Cai S

PROVIDER: S-EPMC7538776 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:BackgroundRecently, immunotherapy (IO) has shown striking survival improvement in unresectable stage III non-small cell lung cancer (NSCLC). However, the role of chemo-radiotherapy (CRT) for improvement in outcomes should not be disregarded. This study aimed to compare the treatment patterns and illustrate the impact of radiotherapy on the cancer-specific survival (CSS) and overall survival (OS) of patients with unresected locally advanced stage III NSCLC.MethodsWe retrospectively analyzed the data of patients with stage III NSCLC patients who did not undergo surgery from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database between 2001 and 2016, and three continuous years were regarded as one unit. Using the Kaplan-Meier method, we identified the CSS and OS. Then, a linear regression model was graphed to analyze the correlation between median survival of CSS or OS and calendar years in the radiotherapy alone, chemotherapy alone, and CRT groups.ResultsA total of 20986 patients were included in this study. In the overall cohort, CSS and OS improved consistently. To explore the reason for the improved survival, patients were divided into three different cohorts: radiotherapy alone, chemotherapy alone, and CRT. From 2001 to 2015, the median CSS improved persistently, 7, 8, 8, 9, and 11 months in the radiotherapy alone group and 12, 13, 15, 17, 19 months in the CRT group, but improvement in outcomes was less consistent in the chemotherapy alone group (10, 9, 11, 12, 12 months). To better visualize the correlation between CSS and calendar year, linear regression was performed, yielding r2 = 0.8032, P = 0.0395 for the radiotherapy alone group; r2 = 0.7206, P = 0.0689 for the chemotherapy alone group; and r2 = 0.9878, P = 0.0006 for the CRT group. Similar findings were observed in the OS data. In addition to this, we also analyzed different pathological types and also obtained the same results.ConclusionsThe survival of patients with unresectable stage III NSCLC has improved substantially, and the most pronounced and consistent improvements were observed in the CRT group. In addition to IO, radiotherapy played an essential role in the treatment of unresectable stage III NSCLC in the past years and should be considered in the design of clinical trials.

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The Prognostic Impact of Age at Diagnosis Upon Breast Cancer of Different Immunohistochemical Subtypes: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Analysis

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