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. 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)

Gretchen G Kimmick  1 , Brittny Major  2 , Jonathan Clapp  3   4 , Jeff Sloan  2 , Brandelyn Pitcher  5   6 , Karla Ballman  7 , Myra Barginear  8 , Rachel A Freedman  9 , Andrew Artz  10 , Heidi D Klepin  11 , Jacqueline M Lafky  2 , Judith Hopkins  12 , Eric Winer  9 , Clifford Hudis  13 , Hyman Muss  14 , Harvey Cohen  5 , Aminah Jatoi  15 , Arti Hurria  16 , Jeanne Mandelblatt  17
Affiliations

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)

Gretchen G Kimmick et al. Breast Cancer Res Treat. 2017 Jun.

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.

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Conflict of interest statement

Conflicts of Interest:

None of the authors has potential conflicts of interest or specific financial interests relevant to the subject of their manuscript.

Figures

Appendix Figure 1
Appendix Figure 1
Observed 2-year Survival by ePrognosis Category
Appendix Figure 2
Appendix Figure 2
Observed 2-year Survival among CALGB/Aliance 49907 Patients by ePrognosis Category
Appendix Figure 3
Appendix Figure 3
Observed 2-year Survival among CALGB/Alliance 369901 Patients by ePrognosis Category
Figure 1
Figure 1
Sample derivation and number of events.
See this image and copyright information in PMC

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References

    1. Muss HB. Adjuvant chemotherapy in older women with breast cancer: who and what? J Clin Oncol. 2014;32(19):1996–2000. doi: 10.1200/JCO.2013.54.8586. - DOI - PubMed
    1. Hurria A. Management of elderly patients with cancer. J Natl Compr Canc Netw. 2013;11(5 Suppl):698–701. - PubMed
    1. Kimmick G. Clinical trial accrual in older cancer patients: The most important steps are the first ones. J Geriatr Oncol. 2016;7(3):158–161. doi: 10.1016/j.jgo.2016.03.006. - DOI - PubMed
    1. Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA. 2012;307(2):182–192. doi:307/2/182 [pii] 10.1001/jama.2011.1966. - PMC - PubMed
    1. Muss HB, Berry DA, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, Partridge AH, Dressler LG, Cohen HJ, Becker HP, Kartcheske PA, Wheeler JD, Perez EA, Wolff AC, Gralow JR, Burstein HJ, Mahmood AA, Magrinat G, Parker BA, Hart RD, Grenier D, Norton L, Hudis CA, Winer EP. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med. 2009;360(20):2055–2065. doi:360/20/2055 [pii] 10.1056/NEJMoa0810266. - PMC - PubMed