Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis
Abstract Background Validation studies of the 21‐gene recurrence score (RS) previously demonstrated that adjuvant chemotherapy plus endocrine therapy (CET) was associated with a significant survival benefit in women with node negative breast cancer (BC) and RS >31. However, the TAILORx trial, did...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.6584 |
| _version_ | 1797654477017186304 |
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| author | Nickolas Stabellini Lifen Cao Christopher W. Towe Amanda L. Amin Alberto J. Montero |
| author_facet | Nickolas Stabellini Lifen Cao Christopher W. Towe Amanda L. Amin Alberto J. Montero |
| author_sort | Nickolas Stabellini |
| collection | DOAJ |
| description | Abstract Background Validation studies of the 21‐gene recurrence score (RS) previously demonstrated that adjuvant chemotherapy plus endocrine therapy (CET) was associated with a significant survival benefit in women with node negative breast cancer (BC) and RS >31. However, the TAILORx trial, did not quantify the benefit of adjuvant CET in older women with node negative hormone receptor positive (HR+) BC with RS ≥26. We hypothesized that CET would be associated with improved overall survival (OS) compared to endocrine therapy (ET) in women >50 with HR+/HER2‐node negative BC and RS ≥26. Methods The National Cancer Database (NCDB) was queried to identify women >50 with RS ≥26 ER+/HER2‐BC pT1‐2N0M0. Chi‐square and logistic regression analysis determined the difference between ET and CET. OS was analyzed using a multivariable Cox model. Results We included 16,745 women—4740 (28.3%) received ET and 12,005 (71.7%) received CET. Women who received CET had: moderately (OR = 1.853, p < 0.001) or poorly/undifferentiated tumors (OR = 3.875, p < 0.001), pT2 (OR = 1.356, p < 0.001), or lymph‐vascular invasion (OR = 1.206, p = 0.001). After accounting for demographic and oncologic factors, 5‐year OS rates were significantly superior in women receiving CET vs. ET alone (95.4% vs. 92.0%, Hazard Ratio = 0.680, p < 0.001). Conclusions We observed that CET was associated with a clinically and statistically significant higher OS compared to ET alone in women >50 years of age with RS ≥26 pT1 and pT2 N0M0 HR+/HER2‐breast cancer, and which suggests that cytotoxic chemotherapy has an impact on reducing mortality that is independent of induction of premature ovarian failure. |
| first_indexed | 2024-03-11T17:00:02Z |
| format | Article |
| id | doaj.art-1e231321697746d6ad6543a1abb9eae6 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-11T17:00:02Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-1e231321697746d6ad6543a1abb9eae62023-10-20T10:25:45ZengWileyCancer Medicine2045-76342023-10-011219196071961610.1002/cam4.6584Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysisNickolas Stabellini0Lifen Cao1Christopher W. Towe2Amanda L. Amin3Alberto J. Montero4Case Western Reserve University School of Medicine Cleveland Ohio USADivision of Hematology and Oncology, Department of Medicine University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine Ohio Cleveland USADivision of Thoracic and Esophageal Surgery, Department of Surgery University Hospitals Research in Surgical Outcomes and Effectiveness (UH‐RISES), University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine Ohio Cleveland USADivision of Surgical Oncology, Department of Surgery University Hospitals Research in Surgical Outcomes and Effectiveness (UH‐RISES), University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine Ohio Cleveland USADivision of Hematology and Oncology, Department of Medicine University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine Ohio Cleveland USAAbstract Background Validation studies of the 21‐gene recurrence score (RS) previously demonstrated that adjuvant chemotherapy plus endocrine therapy (CET) was associated with a significant survival benefit in women with node negative breast cancer (BC) and RS >31. However, the TAILORx trial, did not quantify the benefit of adjuvant CET in older women with node negative hormone receptor positive (HR+) BC with RS ≥26. We hypothesized that CET would be associated with improved overall survival (OS) compared to endocrine therapy (ET) in women >50 with HR+/HER2‐node negative BC and RS ≥26. Methods The National Cancer Database (NCDB) was queried to identify women >50 with RS ≥26 ER+/HER2‐BC pT1‐2N0M0. Chi‐square and logistic regression analysis determined the difference between ET and CET. OS was analyzed using a multivariable Cox model. Results We included 16,745 women—4740 (28.3%) received ET and 12,005 (71.7%) received CET. Women who received CET had: moderately (OR = 1.853, p < 0.001) or poorly/undifferentiated tumors (OR = 3.875, p < 0.001), pT2 (OR = 1.356, p < 0.001), or lymph‐vascular invasion (OR = 1.206, p = 0.001). After accounting for demographic and oncologic factors, 5‐year OS rates were significantly superior in women receiving CET vs. ET alone (95.4% vs. 92.0%, Hazard Ratio = 0.680, p < 0.001). Conclusions We observed that CET was associated with a clinically and statistically significant higher OS compared to ET alone in women >50 years of age with RS ≥26 pT1 and pT2 N0M0 HR+/HER2‐breast cancer, and which suggests that cytotoxic chemotherapy has an impact on reducing mortality that is independent of induction of premature ovarian failure.https://doi.org/10.1002/cam4.6584adjuvant chemotherapyadjuvant endocrine therapybreast cancerER +overall survivalrecurrence score |
| spellingShingle | Nickolas Stabellini Lifen Cao Christopher W. Towe Amanda L. Amin Alberto J. Montero Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis Cancer Medicine adjuvant chemotherapy adjuvant endocrine therapy breast cancer ER + overall survival recurrence score |
| title | Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis |
| title_full | Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis |
| title_fullStr | Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis |
| title_full_unstemmed | Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis |
| title_short | Estimating the overall survival benefit of adjuvant chemo‐endocrine therapy in women over age 50 with pT1‐2N0 early stage breast cancer and 21‐gene recurrence score ≥26: A National Cancer Database analysis |
| title_sort | estimating the overall survival benefit of adjuvant chemo endocrine therapy in women over age 50 with pt1 2n0 early stage breast cancer and 21 gene recurrence score ≥26 a national cancer database analysis |
| topic | adjuvant chemotherapy adjuvant endocrine therapy breast cancer ER + overall survival recurrence score |
| url | https://doi.org/10.1002/cam4.6584 |
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