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  • br Fig Kaplan Meier curves surveying

    2019-09-16


    Fig. 2. Kaplan Meier curves surveying overall survival among patients with high-risk Recurrence Score with and without the use of adjuvant chemotherapy. A. Patients aged 18–69 years (p = .004); B. Patients aged 70 years or older (p = .60).
    Of those patients who do undergo testing, we found comparable dis-tributions of RS risk stratifications between the young and older cohorts. This corresponds with findings of other investigators who have noted that Z-Guggulsterone aggressive breast tumor characteristics are similarly distributed 
    among young and old patients [19]. However, breast cancer in older pa-tients may be diagnosed at a later stage [17]. One study using the SEER database found that advancing age may be associated with a more fa-vorable tumor biology, despite a larger tumor size stage at diagnosis
    Fig. 3. Kaplan Meier curves surveying breast cancer-specific survival among patients with high-risk Recurrence Score with and without the use of adjuvant chemotherapy. A. Patients aged 18–69 years; B. Patients aged 70 years or older.
    [20]. The differences observed in size and stage at presentation are likely secondary to delayed diagnosis and decreased screening in older pa-tients [21]. Similar to our study, a previous evaluation of the SEER data-base and RS performed in 2016 by Petkov et al. demonstrated a higher breast cancer-specific mortality for older patients compared to younger 
    patients [22]. Petkov postulated that the worse survival was likely due to less aggressive treatment of older patients. While we were unable to identify chemotherapy regimens or completion of therapy, in our study chemotherapy use did not improve survival in the older cohort.
    Table 4
    Cox proportional hazard model for factors associated with mortality among patients with a high-risk TAILORx Recurrence Score categorization.
    Patients aged 70 years and older
    Hazard Ratio 95% CI
    P-Value
    Hazard Ratio 95% CI
    P-Value
    Age, years
    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
    Bold text designates statistical significance.
    Currently, there exists a lack of prospective data on the use of adju-vant chemotherapy in older patients. Enrollment of older patients into oncologic clinical trials remains difficult, and two large randomized tri-als evaluating adjuvant therapy for breast cancer in older patients were closed prematurely because of lack of accrual [23, 24]. In the current study, we found that chemotherapy use in the older population is less than in the younger group, with about 50% of older patients with high-risk RS tumors receiving chemotherapy and 70% of young patients with high-risk RS tumors receiving chemotherapy. Our results are sim-ilar to the previous study of the SEER database and RS performed by Petkov et al. [22]. In our study, we found that the use of chemotherapy in older patients with a high-risk RS was not associated with an im-provement in overall survival. Several factors may contribute to the lack of efficacy of adjuvant chemotherapy in this cohort. With advanced age, overall survival may be influenced more by non-cancer related deaths [25, 26]. Similarly, comorbidities in older patients may influence chemotherapy choice to favor a less efficacious but more tolerable reg-imens [27]. Additionally, older patients have been shown to have a higher percentage of incomplete therapy and dropout due to complica-tions of chemotherapy [7].