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Breast Cancer Res Treat. 2017 Jun;163(2):391-398. doi: 10.1007/s10549-017-4188-6. Epub 2017 Mar 10.

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503).

Author information

1
Duke Cancer Institute, Duke University Medical Center, Box 3204, Durham, NC, 29910, USA. gretchen.kimmick@duke.edu.
2
Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA.
3
Department of Oncology, MedStar Georgetown University Medical Center, Washington, DC, USA.
4
Department of Biostatistics, Biomathematics and Bioinformatics, Georgetown University, Washington, DC, USA.
5
Duke Cancer Institute, Duke University Medical Center, Box 3204, Durham, NC, 29910, USA.
6
Alliance Statistics and Data Center, Duke University, Durham, NC, USA.
7
Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, NY, USA.
8
Hofstra-North Shore LIJ School of Medicine, Northwell Health Cancer Institute, Lake Success, NY, USA.
9
Dana-Farber/Partners CancerCare, Boston, MA, USA.
10
University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
11
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
12
Forsyth Regional Cancer Center, Winston-Salem, NC, USA.
13
American Society of Clinical Oncology, Alexandria, VA, USA.
14
UNC Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
15
Mayo Clinic, Rochester, MN, USA.
16
City of Hope, Duarte, CA, USA.
17
Department of Oncology and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center, Georgetown University, Washington, DC, USA.

Abstract

PURPOSE:

Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies.

METHODS:

Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods.

RESULTS:

Patient mean age was 75.8 years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0-2) and few (n = 18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p = 0.001) and 3-6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p = 0.25).

CONCLUSIONS:

ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.

KEYWORDS:

Breast cancer; Elderly; Survival estimates; ePrognosis

PMID:
28283904
PMCID:
PMC5508575
DOI:
10.1007/s10549-017-4188-6
[Indexed for MEDLINE]
Free PMC Article

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