Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx
Background Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aim...
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| Veröffentlicht in: | Annals of surgical oncology 2019-10, Vol.26 (10), p.3152-3158 |
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| creator | Lee, Rachel M. Switchenko, Jeffrey M. Ho, Tran B. Arciero, Cletus A. Bhave, Manali A. Subhedar, Preeti D. |
| description | Background
Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aimed to determine how women ≥ 70 years with intermediate RS were redistributed post-TAILORx and to identify predictors of low RS.
Methods
Patients ≥ 70 years with early-stage, node-negative, ER-positive breast cancers in the National Cancer Database(2006–2014) were included. “Pre-TAILORx” RS were classified as low (0–17), intermediate (18–30), and high (> 30). “Post-TAILORx” RS were classified as low (0–25) and high (> 25).
Results
In total, 14,925 women were included. Average age was 74 years. 60% (
n
= 9009) had low pre-TAILORx RS, 31% (
n
= 4635) intermediate, and 9% (
n
= 1281) high. Of 4635 patients with intermediate RS, 72% (
n
= 3660) were reclassified to low RS. Only 12% (
n
= 1783) of patients received chemotherapy. Of patients with pre-TAILORx intermediate RS who received chemotherapy, 55% (
n
= 417) would have been spared chemotherapy by being reclassified with low RS post-TAILORx. The strongest predictor of post-TAILORx low RS was tumor grade; 95% of well-differentiated had low RS, compared with 56% of poorly/undifferentiated tumors (
p
|
| doi_str_mv | 10.1245/s10434-019-07553-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6736707</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2263026107</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-26274b3009ff91d17c238ba102022a31090c8dc5cb57a0fafbb2f6752ce449253</originalsourceid><addsrcrecordid>eNp9UUuP0zAQjhCIXRb-AAdkiQuXwPgVJxdQVBaoVFFUihAna-I6bVapvWsnK_oz-Me47T6AAyd7_D3GM1-WPafwmjIh30QKgoscaJWDkpLnuwfZKZXpSRQlfZjuUJR5xQp5kj2J8QKAKg7ycXbCKReMK3Wa_ZpGsvDj0DlLFtaMIVhnLPlqfLBkaWMC1qRz5AsOnXVDJPN-ZQMZNuiIAvLDYojEt6ReW_IdQ0A32NU7Ujtyfo39mFTe7fFhY8nnQ4U9mWDqEch7HLDBaEndDqlc1tPZfPHzafaoxT7aZzfnWfbtw_ly8imfzT9OJ_UsN0KJIWcFU6LhAFXbVnRFlWG8bJACA8aQU6jAlCsjTSMVQott07C2UJIZK0TFJD_L3h59L8dma1cmTRew15eh22LYaY-d_htx3Uav_bUuFC8UqGTw6sYg-KsxrUpvu2hs36OzfoyasbIESkXJE_XlP9QLP4a0ij2r4MAKejBkR5YJPsZg27vPUND7xPUxcZ0S14fE9S6JXvw5xp3kNuJE4EdCTJBb23Df-z-2vwE9Cbb0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2263026107</pqid></control><display><type>article</type><title>Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Lee, Rachel M. ; Switchenko, Jeffrey M. ; Ho, Tran B. ; Arciero, Cletus A. ; Bhave, Manali A. ; Subhedar, Preeti D.</creator><creatorcontrib>Lee, Rachel M. ; Switchenko, Jeffrey M. ; Ho, Tran B. ; Arciero, Cletus A. ; Bhave, Manali A. ; Subhedar, Preeti D.</creatorcontrib><description>Background
Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aimed to determine how women ≥ 70 years with intermediate RS were redistributed post-TAILORx and to identify predictors of low RS.
Methods
Patients ≥ 70 years with early-stage, node-negative, ER-positive breast cancers in the National Cancer Database(2006–2014) were included. “Pre-TAILORx” RS were classified as low (0–17), intermediate (18–30), and high (> 30). “Post-TAILORx” RS were classified as low (0–25) and high (> 25).
Results
In total, 14,925 women were included. Average age was 74 years. 60% (
n
= 9009) had low pre-TAILORx RS, 31% (
n
= 4635) intermediate, and 9% (
n
= 1281) high. Of 4635 patients with intermediate RS, 72% (
n
= 3660) were reclassified to low RS. Only 12% (
n
= 1783) of patients received chemotherapy. Of patients with pre-TAILORx intermediate RS who received chemotherapy, 55% (
n
= 417) would have been spared chemotherapy by being reclassified with low RS post-TAILORx. The strongest predictor of post-TAILORx low RS was tumor grade; 95% of well-differentiated had low RS, compared with 56% of poorly/undifferentiated tumors (
p
< 0.001). Smaller tumor size also was associated with low RS. Age was not associated with RS.
Conclusions
With post-TAILORx RS criteria, the vast majority of patients ≥ 70 years can be classified as low-risk and unlikely to benefit from chemotherapy. Given that the elderly have greater rates of chemotherapy-associated complications, reconsideration of routine RS testing in patients ≥ 70 years is warranted. Tumor grade and size also may inform the decision to omit RS testing.</description><identifier>ISSN: 1068-9265</identifier><identifier>ISSN: 1534-4681</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07553-y</identifier><identifier>PMID: 31342377</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Age ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biomarkers, Tumor - genetics ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - genetics ; Breast Neoplasms - metabolism ; Breast Neoplasms - pathology ; Breast Oncology ; Cancer ; Chemotherapy ; Chemotherapy, Adjuvant ; Databases, Factual ; Female ; Follow-Up Studies ; Gene Expression Profiling ; Geriatrics ; Humans ; Medicine ; Medicine & Public Health ; Neoplasm Recurrence, Local - drug therapy ; Neoplasm Recurrence, Local - genetics ; Neoplasm Recurrence, Local - metabolism ; Neoplasm Recurrence, Local - pathology ; Oncology ; Practice Guidelines as Topic - standards ; Prognosis ; Receptor, ErbB-2 - metabolism ; Receptors, Estrogen - metabolism ; Receptors, Progesterone - metabolism ; Surgery ; Surgical Oncology ; Tumors</subject><ispartof>Annals of surgical oncology, 2019-10, Vol.26 (10), p.3152-3158</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-26274b3009ff91d17c238ba102022a31090c8dc5cb57a0fafbb2f6752ce449253</citedby><cites>FETCH-LOGICAL-c474t-26274b3009ff91d17c238ba102022a31090c8dc5cb57a0fafbb2f6752ce449253</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07553-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07553-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31342377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Rachel M.</creatorcontrib><creatorcontrib>Switchenko, Jeffrey M.</creatorcontrib><creatorcontrib>Ho, Tran B.</creatorcontrib><creatorcontrib>Arciero, Cletus A.</creatorcontrib><creatorcontrib>Bhave, Manali A.</creatorcontrib><creatorcontrib>Subhedar, Preeti D.</creatorcontrib><title>Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aimed to determine how women ≥ 70 years with intermediate RS were redistributed post-TAILORx and to identify predictors of low RS.
Methods
Patients ≥ 70 years with early-stage, node-negative, ER-positive breast cancers in the National Cancer Database(2006–2014) were included. “Pre-TAILORx” RS were classified as low (0–17), intermediate (18–30), and high (> 30). “Post-TAILORx” RS were classified as low (0–25) and high (> 25).
Results
In total, 14,925 women were included. Average age was 74 years. 60% (
n
= 9009) had low pre-TAILORx RS, 31% (
n
= 4635) intermediate, and 9% (
n
= 1281) high. Of 4635 patients with intermediate RS, 72% (
n
= 3660) were reclassified to low RS. Only 12% (
n
= 1783) of patients received chemotherapy. Of patients with pre-TAILORx intermediate RS who received chemotherapy, 55% (
n
= 417) would have been spared chemotherapy by being reclassified with low RS post-TAILORx. The strongest predictor of post-TAILORx low RS was tumor grade; 95% of well-differentiated had low RS, compared with 56% of poorly/undifferentiated tumors (
p
< 0.001). Smaller tumor size also was associated with low RS. Age was not associated with RS.
Conclusions
With post-TAILORx RS criteria, the vast majority of patients ≥ 70 years can be classified as low-risk and unlikely to benefit from chemotherapy. Given that the elderly have greater rates of chemotherapy-associated complications, reconsideration of routine RS testing in patients ≥ 70 years is warranted. Tumor grade and size also may inform the decision to omit RS testing.</description><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biomarkers, Tumor - genetics</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - genetics</subject><subject>Breast Neoplasms - metabolism</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Oncology</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gene Expression Profiling</subject><subject>Geriatrics</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Neoplasm Recurrence, Local - genetics</subject><subject>Neoplasm Recurrence, Local - metabolism</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Oncology</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Prognosis</subject><subject>Receptor, ErbB-2 - metabolism</subject><subject>Receptors, Estrogen - metabolism</subject><subject>Receptors, Progesterone - metabolism</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Tumors</subject><issn>1068-9265</issn><issn>1534-4681</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9UUuP0zAQjhCIXRb-AAdkiQuXwPgVJxdQVBaoVFFUihAna-I6bVapvWsnK_oz-Me47T6AAyd7_D3GM1-WPafwmjIh30QKgoscaJWDkpLnuwfZKZXpSRQlfZjuUJR5xQp5kj2J8QKAKg7ycXbCKReMK3Wa_ZpGsvDj0DlLFtaMIVhnLPlqfLBkaWMC1qRz5AsOnXVDJPN-ZQMZNuiIAvLDYojEt6ReW_IdQ0A32NU7Ujtyfo39mFTe7fFhY8nnQ4U9mWDqEch7HLDBaEndDqlc1tPZfPHzafaoxT7aZzfnWfbtw_ly8imfzT9OJ_UsN0KJIWcFU6LhAFXbVnRFlWG8bJACA8aQU6jAlCsjTSMVQott07C2UJIZK0TFJD_L3h59L8dma1cmTRew15eh22LYaY-d_htx3Uav_bUuFC8UqGTw6sYg-KsxrUpvu2hs36OzfoyasbIESkXJE_XlP9QLP4a0ij2r4MAKejBkR5YJPsZg27vPUND7xPUxcZ0S14fE9S6JXvw5xp3kNuJE4EdCTJBb23Df-z-2vwE9Cbb0</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Lee, Rachel M.</creator><creator>Switchenko, Jeffrey M.</creator><creator>Ho, Tran B.</creator><creator>Arciero, Cletus A.</creator><creator>Bhave, Manali A.</creator><creator>Subhedar, Preeti D.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20191001</creationdate><title>Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx</title><author>Lee, Rachel M. ; Switchenko, Jeffrey M. ; Ho, Tran B. ; Arciero, Cletus A. ; Bhave, Manali A. ; Subhedar, Preeti D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-26274b3009ff91d17c238ba102022a31090c8dc5cb57a0fafbb2f6752ce449253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biomarkers, Tumor - genetics</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - genetics</topic><topic>Breast Neoplasms - metabolism</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Oncology</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gene Expression Profiling</topic><topic>Geriatrics</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Neoplasm Recurrence, Local - genetics</topic><topic>Neoplasm Recurrence, Local - metabolism</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Oncology</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Prognosis</topic><topic>Receptor, ErbB-2 - metabolism</topic><topic>Receptors, Estrogen - metabolism</topic><topic>Receptors, Progesterone - metabolism</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Rachel M.</creatorcontrib><creatorcontrib>Switchenko, Jeffrey M.</creatorcontrib><creatorcontrib>Ho, Tran B.</creatorcontrib><creatorcontrib>Arciero, Cletus A.</creatorcontrib><creatorcontrib>Bhave, Manali A.</creatorcontrib><creatorcontrib>Subhedar, Preeti D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Rachel M.</au><au>Switchenko, Jeffrey M.</au><au>Ho, Tran B.</au><au>Arciero, Cletus A.</au><au>Bhave, Manali A.</au><au>Subhedar, Preeti D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>26</volume><issue>10</issue><spage>3152</spage><epage>3158</epage><pages>3152-3158</pages><issn>1068-9265</issn><issn>1534-4681</issn><eissn>1534-4681</eissn><abstract>Background
Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aimed to determine how women ≥ 70 years with intermediate RS were redistributed post-TAILORx and to identify predictors of low RS.
Methods
Patients ≥ 70 years with early-stage, node-negative, ER-positive breast cancers in the National Cancer Database(2006–2014) were included. “Pre-TAILORx” RS were classified as low (0–17), intermediate (18–30), and high (> 30). “Post-TAILORx” RS were classified as low (0–25) and high (> 25).
Results
In total, 14,925 women were included. Average age was 74 years. 60% (
n
= 9009) had low pre-TAILORx RS, 31% (
n
= 4635) intermediate, and 9% (
n
= 1281) high. Of 4635 patients with intermediate RS, 72% (
n
= 3660) were reclassified to low RS. Only 12% (
n
= 1783) of patients received chemotherapy. Of patients with pre-TAILORx intermediate RS who received chemotherapy, 55% (
n
= 417) would have been spared chemotherapy by being reclassified with low RS post-TAILORx. The strongest predictor of post-TAILORx low RS was tumor grade; 95% of well-differentiated had low RS, compared with 56% of poorly/undifferentiated tumors (
p
< 0.001). Smaller tumor size also was associated with low RS. Age was not associated with RS.
Conclusions
With post-TAILORx RS criteria, the vast majority of patients ≥ 70 years can be classified as low-risk and unlikely to benefit from chemotherapy. Given that the elderly have greater rates of chemotherapy-associated complications, reconsideration of routine RS testing in patients ≥ 70 years is warranted. Tumor grade and size also may inform the decision to omit RS testing.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31342377</pmid><doi>10.1245/s10434-019-07553-y</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Annals of surgical oncology, 2019-10, Vol.26 (10), p.3152-3158 |
| issn | 1068-9265 1534-4681 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Age Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biomarkers, Tumor - genetics Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - genetics Breast Neoplasms - metabolism Breast Neoplasms - pathology Breast Oncology Cancer Chemotherapy Chemotherapy, Adjuvant Databases, Factual Female Follow-Up Studies Gene Expression Profiling Geriatrics Humans Medicine Medicine & Public Health Neoplasm Recurrence, Local - drug therapy Neoplasm Recurrence, Local - genetics Neoplasm Recurrence, Local - metabolism Neoplasm Recurrence, Local - pathology Oncology Practice Guidelines as Topic - standards Prognosis Receptor, ErbB-2 - metabolism Receptors, Estrogen - metabolism Receptors, Progesterone - metabolism Surgery Surgical Oncology Tumors |
| title | Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx |
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