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Buyrukoğlu G. Survival analysis in breast cancer: evaluating ensemble learning techniques for prediction. PeerJ Comput Sci 2024; 10:e2147. [PMID: 39145224 PMCID: PMC11323082 DOI: 10.7717/peerj-cs.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/30/2024] [Indexed: 08/16/2024]
Abstract
Breast cancer is most commonly faced with form of cancer amongst women worldwide. In spite of the fact that the breast cancer research and awareness have gained considerable momentum, there is still no one treatment due to disease heterogeneity. Survival data may be of specific interest in breast cancer studies to understand its dynamic and complex trajectories. This study copes with the most important covariates affecting the disease progression. The study utilizes the German Breast Cancer Study Group 2 (GBSG2) and the Molecular Taxonomy of Breast Cancer International Consortium dataset (METABRIC) datasets. In both datasets, interests lie in relapse of the disease and the time when the relapse happens. The three models, namely the Cox proportional hazards (PH) model, random survival forest (RSF) and conditional inference forest (Cforest) were employed to analyse the breast cancer datasets. The goal of this study is to apply these methods in prediction of breast cancer progression and compare their performances based on two different estimation methods: the bootstrap estimation and the bootstrap .632 estimation. The model performance was evaluated in concordance index (C-index) and prediction error curves (pec) for discrimination. The Cox PH model has a lower C-index and bigger prediction error compared to the RSF and the Cforest approach for both datasets. The analysis results of GBSG2 and METABRIC datasets reveal that the RSF and the Cforest algorithms provide non-parametric alternatives to Cox PH model for estimation of the survival probability of breast cancer patients.
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Affiliation(s)
- Gonca Buyrukoğlu
- Department of Statistics/ Faculty of Science, Çankırı Karatekin University, Çankırı, Turkey
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2
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Liu K, Huang AL, Chen XQ, Wu SG. Patterns of distant metastasis and survival outcomes in de novo metastatic breast cancer according to age groups. Front Endocrinol (Lausanne) 2024; 15:1385756. [PMID: 38752173 PMCID: PMC11094241 DOI: 10.3389/fendo.2024.1385756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Background Is de novo metastatic breast cancer (dnMBC) the same disease in the elderly as in younger breast cancer remains unclear. This study aimed to determine the metastatic patterns and survival outcomes in dnMBC according to age groups. Methods We included patients from the Surveillance Epidemiology and End Results program. Chi-square test, multivariate logistic regression analyses, and multivariate Cox regression models were used for statistical analyses. Results A total of 17719 patients were included. There were 3.6% (n=638), 18.6% (n=3290), 38.0% (n=6725), and 39.9% (n=7066) of patients aged <35, 35-49, 50-64, and ≥65 years, respectively. Older patients had a significantly higher risk of lung metastasis and a significantly lower risk of liver metastasis. There were 19.1%, 25.6%, 30.9%, and 35.7% of patients with lung metastasis in those aged <35, 35-49, 50-64, and ≥65 years, respectively. Moreover, the proportion of liver metastasis was 37.6%, 29.5%, 26.3%, and 19.2%, respectively. Age was the independent prognostic factor associated with breast cancer-specific survival (BCSS) and overall survival (OS). Those aged 50-64 years had significantly inferior BCSS (P<0.001) and OS (P<0.001) than those aged <35 years. Patients aged ≥65 years also had significantly lower BCSS (P<0.001) and OS (P<0.001) than those aged <35 years. However, similar outcomes were found between those aged 35-49 and <35 years. Conclusion Our study suggests that different age groups may affect the metastatic patterns among patients with dnMBC and the survival of younger patients is more favorable than those of older patients.
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Affiliation(s)
- Ke Liu
- Xiamen Key Laboratory of Clinical Efficacy and Evidence Studies of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - An-Le Huang
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xue-Qin Chen
- Xiamen Key Laboratory of Clinical Efficacy and Evidence Studies of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Quality Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Hemida AS, Shabaan MI, Taha MA, Abdou AG. Impact of immunohistochemical expression of kinesin family member 18A (Kif18A) and β-catenin in infiltrating breast carcinoma of no special type. World J Surg Oncol 2024; 22:15. [PMID: 38195458 PMCID: PMC10777553 DOI: 10.1186/s12957-023-03276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND KIF18A is a regulator of the cell cycle that stimulates the proliferation of cancer cells. The Wnt/β-catenin pathway is involved in different issues' carcinogenesis and is being examined as a therapeutic target. The relationship between KIF18A and β-catenin in breast cancer was not previously investigated. Therefore, this work aims to study the immunohistochemical expression and correlation of KIF18A and β-catenin in breast-infiltrating duct carcinoma (IDC) and their relation to prognosis. MATERIAL AND METHODS Slides cut from paraffin blocks of 135 IDC and 40 normal breast tissues were stained by KIF18A and β-catenin antibodies. KIF18A cytoplasmic or nucleocytoplasmic staining and β-catenin aberrant expression either nucleo-cytoplasmic or cytoplasmic staining were considered. RESULTS Normal breast tissue and IDC showed a significant difference regarding KIF18A and aberrant β-catenin expression. High KIF18A and β-catenin H score values were associated with poor prognostic factors such as high grade, advanced stage, distant metastasis, high Ki67 status, and Her2neu-enriched subtype. There was a significant direct correlation between KIF18A and β-catenin as regards percent and H score values. Prolonged overall survival (OS) was significantly associated with mild intensity and low H score of KIF18A, and low β-catenin H score. CONCLUSIONS KIF18A could be involved in breast carcinogenesis by activating β-catenin. Overexpression of KIF18A and aberrant expression of β-catenin are considered proto-oncogenes of breast cancer development. KIF18A and β-catenin could be poor prognostic markers and predictors of aggressive behavior of breast cancer.
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Affiliation(s)
- Aiat Shaban Hemida
- Pathology Department, Faculty of Medicine, Menoufia University, Yassin Abd Elghafar Street, Shebin El Kom, 32511, Egypt.
| | - Mohammed Ibrahim Shabaan
- Pathology Department, Faculty of Medicine, Menoufia University, Yassin Abd Elghafar Street, Shebin El Kom, 32511, Egypt
| | - Mennatallah Ahmed Taha
- Pathology Department, Faculty of Medicine, Menoufia University, Yassin Abd Elghafar Street, Shebin El Kom, 32511, Egypt
| | - Asmaa Gaber Abdou
- Pathology Department, Faculty of Medicine, Menoufia University, Yassin Abd Elghafar Street, Shebin El Kom, 32511, Egypt
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Tarlan M, Khazaei S, Madani SH, Saleh E. Prognostic factors for cancer-specific survival in 220 patients with breast cancer: A single center experience. Cancer Rep (Hoboken) 2022; 6:e1675. [PMID: 35931659 PMCID: PMC9875637 DOI: 10.1002/cnr2.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Hospital-based breast cancer survival studies are scarce in western Iran. Furthermore, the relationship between breast cancer survival and clinical parameters has been extensively studied, but many of the findings come from developing countries. This paper aims to estimate the survival of hospital-based breast cancer patients and its predictor factors. METHOD This retrospective analysis was conducted on 578 patients with primary breast cancer who underwent surgery between 2004 and 2020. Information was collected from medical reports by the Hospital information system in Imam Reza Hospital, Kermanshah, Iran. One-, 2-, 5-, and 10-year breast cancer-specific survival has been calculated using the Kaplan-Meier process. Crude and adjusted Hazard Ratios (HR) were calculated using the Cox proportional regression model. RESULT One-, 2-, and 5-year overall breast cancer survival were 219 (99.54%), 196 (89.09%), 159 (72.27%), and 70 (31.81%), respectively. Univariate analysis of breast cancer patients with tumor-related variables revealed that factors such as age, menopause status, lymph node metastasis, number of lymph nodes, organ metastasis, and stage of disease were significantly associated with disease-specific survival (p < .05). Multivariate analysis demonstrated that metastasis (HR = 41.77, 95% CI: 15.3-114.15) and lymph node metastasis (HR = 5.26, 95% CI: 1.9-14.6) were significantly related to survival. CONCLUSION The findings demonstrate that survival is relatively low and is consistent with late-stage disease diagnosis. It is believed that this is due to a poor level of awareness, lack of screening programs, and subsequent late access to treatment.
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Affiliation(s)
- Mitra Tarlan
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Sedigheh Khazaei
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Seyed Hamid Madani
- Molecular Pathology Research CenterImam Reza Hospital, Kermanshah Universitiy of Medical ScienceKermanshahIran
| | - Elaheh Saleh
- Department of Health Education and Health Promotion, Faculty of HealthSemnan University of Medical ScienceSemnanIran
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Tagliabue G, Fabiano S, Contiero P, Barigelletti G, Castelli M, Mazzoleni G, Boschetti L, Fanetti AC, Puppo A, Musolino A, Cirilli C, Seghini P, Mangone L, Caldarella A, Lotti F, Mazzucco W, Benedetto A, Dinaro YM, Sferrazza A, Pinna P, Perotti V. Molecular Subtypes, Metastatic Pattern and Patient Age in Breast Cancer: An Analysis of Italian Network of Cancer Registries (AIRTUM) Data. J Clin Med 2021; 10:jcm10245873. [PMID: 34945169 PMCID: PMC8706111 DOI: 10.3390/jcm10245873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Breast cancer stage at diagnosis, patient age and molecular tumor subtype influence disease progression. The aim of this study was to analyze the relationships between these factors and survival in breast cancer patients among the Italian population using data from the AIRTUM national database. We enrolled women with primary breast cancer from 17 population-based cancer registries. Patients were subdivided into older (>69 years), middle (50–69 years) and younger age groups (<50 years) and their primary tumors categorized into four molecular subtypes based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. There were 8831 patients diagnosed between 2010 and 2012 included. The most represented age group was 50–69 years (41.7%). In 5735 cases the molecular subtype was identified: HER2–/HR+ was the most frequent (66.2%) and HER2+/HR− the least (6.2%). Of the 390 women with metastases at diagnosis, 38% had simultaneous involvement of multiple sites, independent of age and molecular profile. In women with a single metastatic site, bone (20% of cases), liver (11%), lung (7%) and brain (3%) were the most frequent. In the studied age groups with different receptor expression profiles, the tumor metastasized to target organs with differing frequencies, affecting survival. Five-year survival was lowest in women with triple-negative (HER2−/HR–) tumors and women with brain metastases at diagnosis.
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Affiliation(s)
- Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.F.); (G.B.); (V.P.)
- Correspondence:
| | - Sabrina Fabiano
- Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.F.); (G.B.); (V.P.)
| | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Giulio Barigelletti
- Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.F.); (G.B.); (V.P.)
| | - Maurizio Castelli
- Cancer Registry, Aosta Valley Health Authorities Department of Public Health, 11100 Aosta, Italy;
| | - Guido Mazzoleni
- Cancer Registry, South-Tyrol Local Health Trust, 39100 Bolzano, Italy;
| | - Lorenza Boschetti
- Cancer Registry, Epidemiology Monitoring Unit, Public Health Agency of Pavia, 27100 Pavia, Italy;
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Health Protection Agency, 23100 Sondrio, Italy;
| | - Antonella Puppo
- Clinical Epidemiology Unit, Liguria Cancer Registry, IRCCS-Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Medical Oncology, Cancer Registry, University Hospital of Parma, 43100 Parma, Italy;
| | | | - Pietro Seghini
- Cancer Registry, Department of Epidemiology, Piacenza General Hospital, 29121 Piacenza, Italy;
| | - Lucia Mangone
- Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy;
| | - Adele Caldarella
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy;
| | - Fernanda Lotti
- Section of the Puglia Cancer Registry, Cancer Registry, Local Health Unit Brindisi, 72100 Brindisi, Italy;
| | - Walter Mazzucco
- Department of Sciences for Health Promotion and Mother and Child Care “Giuseppe D’Alessandro”, University of Palermo, 90128 Palermo, Italy;
| | - Andrea Benedetto
- Integrated Cancer Registry of Catania-Messina-Enna, Department of Hygiene and Public Health, 95100 Catania, Italy;
| | | | - Ausilia Sferrazza
- Ragusa Cancer Registry, Provincial Health Unit, 97100 Ragusa, Italy;
| | - Pasquala Pinna
- Nuoro Cancer Registry, ASSL Nuoro/ATS Sardegna, 08100 Nuoro, Italy;
| | - Viviana Perotti
- Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.F.); (G.B.); (V.P.)
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Refining breast cancer prognosis by incorporating age at diagnosis into clinical prognostic staging: introduction of a novel online calculator. Breast Cancer Res Treat 2021; 187:805-814. [PMID: 33609208 DOI: 10.1007/s10549-021-06113-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE American Joint Committee on Cancer (AJCC) clinical staging is used to estimate breast cancer prognosis, but individual patient survival within each stage varies considerably by age at diagnosis. We hypothesized that the addition of age at diagnosis to the staging schema will enable more refined risk stratification. METHODS We performed a retrospective population analysis of adult women diagnosed with invasive breast cancer between 2010 and 2015 registered in SEER. Multivariable Cox hazards models were used to evaluate the association of AJCC 8th edition clinical prognostic stage (CPS) and age with risk of overall mortality. Separate hierarchical models were fit to the data: Model 1: CPS alone; Model 2: CPS + age + age2; and Model 3: CPS + age + age2 + CPS x age + CPS x age2. Models were compared by the Akaike information criterion (AIC), the c-statistic for time-dependent receiver operator characteristic curves, and category-free net reclassification improvement (NRI). Internal validation was performed using bootstrapping samples. RESULTS Among 86,637 women, the median follow-up was 36 months and 3-year overall survival was 91.9% ± 0.1%. Age significantly modified the effect of CPS on survival (p < 0.0001). Model 3 was the most precise, with the lowest AIC (126,619.63), the highest c-statistic (0.8212, standard error 0.0187), and superior NRI indices. CONCLUSION Age at diagnosis is a highly prognostic variable that warrants consideration for inclusion in future editions of the AJCC Breast Cancer Staging Manual.
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Quantifying the relationship between age at diagnosis and breast cancer-specific mortality. Breast Cancer Res Treat 2019; 177:713-722. [DOI: 10.1007/s10549-019-05353-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
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Sarveazad A, Babahajian A, Shamseddin J, Bahardoust M. 5-Year Survival Rates and Prognostic Factors in Patients with Synchronus and Metachronus Breast Cancer from 2010 to 2015. Asian Pac J Cancer Prev 2018; 19:3489-3493. [PMID: 30583674 PMCID: PMC6428561 DOI: 10.31557/apjcp.2018.19.12.3489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Currently breast (BC) cancer is a serious medical problem in all countries of the world. Survival depends on many factors. The present study focused on 5-year survival and its related factors in patients with BC in Iran. Material and methods. The present analytical retrospective study was performed (from March 2010 until March 2015) on patients with BC followed for at least 6 months. The main variables assessed were tumor size, grade of lymph node involvement, metastasis, stage, history, human epidermal growth factor receptor expression, and tumor origin. Analysis of survival was accomplished using the Kaplan- Meier method. Results: Some 351 (80.2%) of the total of 438 individuals had unilateral and 87(19.8%) had bilateral cancer, 28 (35.6%) of the latter being synchronous and 56(64.4%) metachronous. Mean duration of follow-up was 47.44±28.19 months, during which 61 (17.3%) patients with unilateral and 18 with bilateral cancer eventually died. The 5-year survival rate in patients with unilateral BC was significantly higher than those with bilateral BC (Log-rank Test chi2= 3.11, p=0.032). In addition, with metachronous cases, the survival rate was 64.2% in comparison with 51.6% for synchronous BCs. Survival rate was significantly (p value =0.038) higher with metachronous than with synchronous cancers (Log-rank Test chi2=3.54, p=0.038). The highest survival rate was reported for BCs originating from lobule tissue and the lowest rate examples of interstitial tissue origin (Log-rank Test chi2=11.54, p=0.0001). Patients with earl stage lesions (M1) survived longer than with other stages (Log-rank Test chi2= 9.55, p=0.001). Conclusion: In this study, most women with BC had a positive family history and were married. The 5-year survival rate was lower with advanced stages of cancer. According to our findings, survival rates might improve if patients undergo screening and diagnosis is made at an early stage of the disease.
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Affiliation(s)
- Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Li M, Morrell S, Creighton N, Tervonen H, You H, Roder D, Currow D. Has cancer survival improved for older people as for younger people? New South Wales, 1980–2012. Cancer Epidemiol 2018; 55:23-29. [DOI: 10.1016/j.canep.2018.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 01/22/2023]
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Fokter Dovnik N, Arko D, Čas Sikošek N, Takač I. Survival of Node-negative Breast Cancer Patients Treated at the University Medical Centre Maribor in the Period 2000-2009. Zdr Varst 2017; 56:185-192. [PMID: 28713448 PMCID: PMC5504545 DOI: 10.1515/sjph-2017-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 04/21/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Breast cancer is increasingly diagnosed in the early stages without regional nodal involvement. The aim of the present study was to determine the 5-year overall (OS) and breast cancer specific survival (BCSS) for patients with node-negative breast cancer treated at the University Medical Centre Maribor, and compare it with survival at the national level. Methods Medical records were searched for information on patients with lymph node-negative invasive breast cancer who received primary treatment at the University Medical Centre Maribor in the period 2000–2009. Information on all Slovenian node-negative breast cancer patients diagnosed in the same period was obtained from the Cancer Registry of Republic of Slovenia. Time trends in survival were assessed by comparing the periods 2000–2004 and 2005–2009. Results The 5-year OS and BCSS of patients treated in Maribor in the period 2000–2009 were 92.3% (95% CI, 90.5%– 94.1%) and 96.4% (95% CI, 95.2%–97.6%), respectively, and did not differ from the corresponding OS and BCSS for Slovenian patients. Although the improvement in OS for patients from Maribor diagnosed in the period 2005–2009 compared to 2000–2004 did not reach statistical significance (HR 0.73; 95% CI, 0.51–1.05; p=0.086), BCSS significantly improved over the same time periods (HR 0.53; 95% CI, 0.30–0.94; p=0.028). Conclusions Survival of node-negative breast cancer patients treated at the University Medical Centre Maribor is comparable to survival of corresponding patients at the national level. The rising number of long-term breast cancer survivors places additional importance on survivorship care.
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Affiliation(s)
- Nina Fokter Dovnik
- University Medical Centre Maribor, Department of Oncology, Ljubljanska 5, 2000Maribor, Slovenia
| | - Darja Arko
- University Medical Centre Maribor, University Clinical Department of Gynaecology and Perinatology, Ljubljanska 5, 2000MariborSlovenia
| | - Nina Čas Sikošek
- University Medical Centre Maribor, University Clinical Department of Gynaecology and Perinatology, Ljubljanska 5, 2000MariborSlovenia
| | - Iztok Takač
- University Medical Centre Maribor, University Clinical Department of Gynaecology and Perinatology, Ljubljanska 5, 2000MariborSlovenia.,University of Maribor, Faculty of Medicine, Taborska 8, 2000MariborSlovenia
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Chen HL, Zhou MQ, Tian W, Meng KX, He HF. Effect of Age on Breast Cancer Patient Prognoses: A Population-Based Study Using the SEER 18 Database. PLoS One 2016; 11:e0165409. [PMID: 27798652 PMCID: PMC5087840 DOI: 10.1371/journal.pone.0165409] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/13/2016] [Indexed: 01/04/2023] Open
Abstract
Background Age is an important risk factor for breast cancer, but data regarding whether patient age at diagnosis is related to breast cancer survival are conflicting. This population-based study evaluated the effect of age on breast cancer prognosis and identified outcome-related factors. Patients and Methods We searched the Surveillance, Epidemiology, and End Results (SEER) database and enrolled female primary non-metastatic cases. Patients were subdivided into seven groups, and analyses of the associations between age and overall survival (OS) and breast cancer-specific survival (BCSS) were carried out using the Kaplan-Meier method and Cox regression model, respectively. We also assessed differences in survival among three specific age groups, using the ages of 30 and 50 years as cut-offs. Stratified analyses regarding race, histology, grade, stage and hormone receptor status were also carried out. Results A total of 133,057 female patients diagnosed with breast cancer from 2004 to 2008 were included in the current study (6.4% <40 years), Women aged 40 to 49 years and 60 to 69 years exhibited significantly better OS and BCSS, respectively (log-rank, p<0.001), than their counterparts in other groups. Middle-aged women exhibited distinctly better OS (log-rank, p<0.001) and BCSS (log-rank, p<0.001) than their counterparts in the other two age groups. Following adjustments for potential confounding factors, middle-age at breast cancer diagnosis was shown to be an independent predictor of favourable outcomes in terms of OS, but not BCSS (for OS, HR, 0.92; 95%CI, 0.87–0.98; p = 0.007; for BCSS, HR, 0.94; 95%CI, 0.80–1.01; p = 0.075, using the young group as reference). Stratified analysis showed that middle-age was significantly associated with increased survival, except among patients with stage III disease, and that elderly women faced worse prognoses than younger patients. Conclusion Our results indicate that younger breast cancer patients exhibit more aggressive disease than older patients. Middle-aged patients exhibit better OS and BCSS than young and elderly patients but exhibit BCSS rates similar to those of young patients after adjustments for confounders. Stratified analysis demonstrated that middle-aged patients exhibited better survival than young patients, with the exception of patients with stage III disease. An age of 60 years or more was a significant independent predictor of a poor prognosis.
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Affiliation(s)
- Hai-long Chen
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
- * E-mail:
| | - Mei-qi Zhou
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wei Tian
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ke-xin Meng
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Hai-fei He
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Liu YR, Jiang YZ, Yu KD, Shao ZM. Different patterns in the prognostic value of age for breast cancer-specific mortality depending on hormone receptor status: a SEER population-based analysis. Ann Surg Oncol 2014; 22:1102-10. [PMID: 25249260 DOI: 10.1245/s10434-014-4108-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Few studies have been undertaken to evaluate the prognostic value of age at diagnosis for determining breast cancer survival in a large population. METHODS Using the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database consisting of 18 population-based cancer registries, this study identified 331,969 female patients with a diagnosis of breast cancer from 1 January 1990, to 31 December 31. Breast cancer-specific mortality (BCSM) was compared among patients in different age groups using Kaplan-Meier plots. The Cox proportional hazards model was used for multivariate analysis. RESULTS In the multivariate analysis, the hazard ratios (HRs) of BCSM in the different age groups formed a U-shaped curve, with patients younger than 30 years and patients older than 79 years experiencing the worst survival rates (HR, 1.19; 95 % confidence interval [CI], 1.06-1.33; P = 0.003 and HR, 2.16; 95 % CI, 2.05-2.27; P < 0.001, with age 50-59 years as the reference, respectively). When the interaction between age at diagnosis and hormone receptor (HoR) status for prediction of BCSM was further analyzed, the findings showed that in the HoR-positive group, patients younger than 30 years and patients older than 79 years had the worst survival rates (HR, 1.52; 95 % CI, 1.30-1.76; P < 0.001 and HR, 2.07; 95 % CI, 1.94-2.20; P < 0.001, respectively), whereas patients ages 40 to 49 years had the best survival rate (HR, 0.93; 95 % CI, 0.89-0.98; P = 0.005). This pattern, however, was different in the HoR-negative group. Patients younger than 60 years had nearly the same BCSM (P = 0.356, 0.199, and 0.036 for ages <30 years, 30-39 years, and 40-49 years, respectively), with BCSM starting to increase with age only for patients older than 60 years and peaking for patients older than 79 years (HR, 2.39; 95 % CI, 2.20-2.59; P < 0.001). CONCLUSIONS The study findings show different patterns in the prognostic value of age for determining BCSM, depending on the HoR status. These data underscore the importance of age-specific studies for different HoR groups to individualize treatment and improve outcomes for breast cancer patients.
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Affiliation(s)
- Yi-Rong Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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Roder D, Zorbas HM, Kollias J, Pyke CM, Walters D, Campbell ID, Taylor C, Webster F. Analysing risk factors for poorer breast cancer outcomes in residents of lower socioeconomic areas of Australia. AUST HEALTH REV 2014; 38:134-41. [PMID: 24709287 DOI: 10.1071/ah13080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 10/22/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate patient, cancer and treatment factors associated with the residence of female breast cancer patients in lower socioeconomic areas of Australia to better understand factors that may contribute to their poorer cancer outcomes. METHODS Bivariable and multivariable analyses were performed using the Breast Quality Audit database of Breast Surgeons of Australia and New Zealand. RESULTS Multivariable regression indicated that patients from lower socioeconomic areas are more likely to live in more remote areas and to be treated at regional than major city centres. Although they appeared equally likely to be referred to surgeons from BreastScreen services as patients from higher socioeconomic areas, they were less likely to be referred as asymptomatic cases from other sources. In general, their cancer and treatment characteristics did not differ from those of women from higher socioeconomic areas, but ovarian ablation therapy was less common for these patients and bilateral synchronous lesions tended to be less frequent than for women from higher socioeconomic areas. CONCLUSIONS The results indicate that patients from lower socioeconomic areas are more likely to live in more remote districts and have their treatment in regional rather than major treatment centres. Their cancer and treatment characteristics appear to be similar to those of women from higher socioeconomic areas, although they are less likely to have ovarian ablation or to be referred as asymptomatic patients from sources other than BreastScreen. What is known about this topic? It is already known from Australian data that breast cancer outcomes are not as favourable for women from areas of socioeconomic disadvantage. The reasons for the poorer outcomes have not been understood. Studies in other countries have also found poorer outcomes in women from lower socioeconomic areas, and in some instances, have attributed this finding to more advanced stages of cancers at diagnosis and more limited treatment. The reasons are likely to vary with the country and health system characteristics. What does this paper add? The present study found that in Australia, women from lower socioeconomic areas do not have more advanced cancers at diagnosis, nor, in general, other cancer features that would predispose them to poorer outcomes. The standout differences were that they tended more to live in areas that were more remote from specialist metropolitan centres and were more likely to be treated in regional settings where prior research has indicated poorer outcomes. The reasons for these poorer outcomes are not known but may include lower levels of surgical specialisation, less access to specialised adjunctive services, and less involvement with multidisciplinary teams. Women from lower socioeconomic areas also appeared more likely to attend lower case load surgeons. Little difference was evident in the type of clinical care received, although women from lower socioeconomic areas were less likely to be asymptomatic referrals from other clinical settings (excluding BreastScreen). What are the implications for practitioners? Results suggest that poorer outcomes in women from lower socioeconomic areas in Australia may have less to do with the characteristics of their breast cancers or treatment modalities and more to do with health system features, such as access to specialist centres. This study highlights the importance of demographic and health system features as potentially key factors in service outcomes. Health system research should be strengthened in Australia to augment biomedical and clinical research, with a view to best meeting service needs of all sectors of the population.
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Affiliation(s)
- David Roder
- Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia.
| | - Helen M Zorbas
- Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia.
| | - James Kollias
- Breast Quality Audit Steering Committee, Breast Surgeons of Australia and New Zealand, Botany, NSW 1455, Australia
| | - Chris M Pyke
- Breast Quality Audit Steering Committee, Breast Surgeons of Australia and New Zealand, Botany, NSW 1455, Australia
| | - David Walters
- Breast Quality Audit Steering Committee, Breast Surgeons of Australia and New Zealand, Botany, NSW 1455, Australia
| | - Ian D Campbell
- Breast Quality Audit Steering Committee, Breast Surgeons of Australia and New Zealand, Botany, NSW 1455, Australia
| | - Corey Taylor
- Breast Quality Audit, Royal Australasian College of Surgeons, 199 Ward St, North Adelaide, SA 5006, Australia.
| | - Fleur Webster
- Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia.
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Testing the 'teachable moment' premise: does physical activity increase in the early survivorship phase? Support Care Cancer 2013; 22:989-97. [PMID: 24281728 DOI: 10.1007/s00520-013-2064-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/15/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Little is known about objectively measured physical activity during the early survivorship period. This study measured physical activity, fatigue, and quality of life (QOL) in breast cancer patients over the first year after completion of chemotherapy and compared results to a matched non-cancer group. METHODS Data was obtained from 24 breast cancer subjects (mean ± SD) 50.9 ± 12.8 years at time points of 6 weeks, 6 months and 1 year after completion of adjuvant chemotherapy and from 20 matched women. The following variables were assessed, physical activity (RT3 accelerometer and International Physical Activity Questionnaire), quality-of-life (EORTC QLQ C-30) and fatigue (Brief Fatigue Inventory). RESULTS At 6 weeks after completion of chemotherapy, high levels of sedentary behaviour were found (6.8 ± 1.9 h sedentary per day), which did not improve, and was no different to the comparison group (6.5 ± 1.4 h). Less light activity was performed in the cancer cohort compared to the comparison group (p = 0.003). Body mass index (BMI) increased significantly in the cancer cohort (p = 0.015) and 1 year after chemotherapy finished only 13% (n = 3) had a BMI <25, while the comparable value was 45% (n = 9) in the non-cancer group. The QOL domain of cognitive function improved over the first 6 months (p = 0.034) but physical functioning declined (p = 0.008) over this time period. Fatigue did not change, and at the 1-year time point, 38% of the cancer patients (n = 11) reported high levels of fatigue. CONCLUSION This study highlighted the unchanging sedentary behaviour and weight gain of breast cancer survivors during the first year after completion of chemotherapy, which may inform rehabilitation models in this population.
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