Elderly Breast Cancer Research Articles

Prevalence and impact of metabolic associated fatty liver disease in non-metastatic breast cancer women at initial diagnosis: a cross-sectional study in China.

The epidemiologic data of metabolic associated fatty liver disease (MAFLD) in breast cancer (BC) patients remains limited. We aimed to investigate the prevalence and clinicopathological characteristics of hepatic steatosis (HS) and MAFLD in Chinese BC women at initial diagnosis. 3217 non-metastatic primary BC women with MAFLD evaluation indexes at initial diagnosis and 32,170 age-matched (in a 1:10 ratio) contemporaneous health check-up women were enrolled. The prevalence of HS (21.5% vs. 19.7%, p = 0.013) and MAFLD (20.8% vs. 18.6%, p = 0.002) were significantly higher in BC women than in health check-ups, respectively. Meanwhile, the prevalence of HS/MAFLD among elderly BC women (≥ 60years) was significantly higher than the health check-ups (38.7%/37.6% vs 31.9%/30.8%), respectively. In BC women with HS/MAFLD, the prevalence of overweight/obesity was up to 85.7%/88.6%, dyslipidemia and elevated blood pressure were 63.2%/63.7% and 59.7%/61.7%, respectively. No statistical significance of the expressions of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER-2) and Ki67 were found between BC women with HS/MAFLD and BC women without HS/MAFLD. After adjustment, BC women with HS showed significantly higher risk of lymph node metastasis than BC women without HS. Subjects with HS/MAFLD had higher risks of overweight/obesity, dyslipidemia, elevated blood pressure, hyperuricemia, and elevated enzymes than those without HS/MAFLD. Compared with health check-ups, BC patients have higher prevalence of HS/MAFLD. HS/MAFLD coexist with high prevalence of metabolic complications, and the risk of lymph node metastasis was significantly higher in BC women with HS than in BC women without HS.

The Use of Cyclin-Dependent Kinase 4/6 Inhibitors in Elderly Breast Cancer Patients: What Do We Know?

Breast cancer (BC) incidence increases with age, particularly in HR-positive/HER2-negative subtypes. Cyclin-dependent kinase 4 and 6 inhibitors (CDK 4/6is) alongside endocrine therapy (ET) have emerged as promising treatments for HR-positive/HER2-negative advanced and early BC. However, their efficacy, safety, and impact on quality of life (QoL) in older and frail patients remain underexplored. This position paper assesses the existing literature from 2015 to 2024, focusing on CDK4/6is use in patients aged 65 years and older with HR-positive/HER2-negative BC. Our analysis methodically addresses critical questions regarding the utilization of CDK4/6is in the elderly BC patient population, organizing findings from the metastatic and adjuvant settings. In the metastatic setting, CDK4/6is significantly improve progression-free survival (PFS), paralleling benefits observed in younger patients, and suggest potential overall survival (OS) benefits, warranting further investigation. Despite an increased incidence of grade ≥ 3 adverse events (AEs), such as neutropenia and asthenia, CDK4/6is present a markedly lower toxicity profile compared to traditional chemotherapy, with manageable side effects. QoL analysis indicates that integrating CDK4/6is into treatment regimens does not significantly impact elderly BC patients' daily life and symptom management. Special attention is given to frail subgroups, and personalized approaches are recommended to balance efficacy and adverse effects, such as starting with ET alone and introducing CDK4/6is upon progression in patients with a low disease burden. Transitioning to the adjuvant setting, early results, particularly with abemaciclib, indicate positive effects on disease-free survival (DFS), emphasizing the need for continued analysis to validate these findings and assess long-term implications. However, data on older patients are insufficient to conclude whether they truly benefit from this treatment. Overall, CDK4/6is present a favorable benefit-risk profile in older BC patients, at least in advanced BC; however, further research is warranted to optimize treatment strategies and improve outcomes in this population.

Clinical value of KiSS-1 and MMP-2 expression levels in breast cancer tissue in evaluating prognosis of elderly breast cancer patients after modified radical mastectomy.

We attempted to clarify clinical value of KiSS-1 and MMP-2 levels in breast cancer (BC) tissue in evaluating prognosis of elderly BC patients after modified radical mastectomy (MCM). The data of 192 elderly female BC patients receiving MCM in our hospital from January 2018 to December 2022 were collected. According to prognosis, patients received division into poor prognosis group (n = 43) and good prognosis group (n = 149). The serum CEA level and KiSS-1 and MMP-2 levels in BC tissue received measurement in both groups. The predictive value of KiSS-1 and MMP-2 alone and jointly in adverse prognosis of elderly BC patients after MCM received assessment. Results showed that No statistical significance was exhibited between both groups in general data (P > 0.05). The serum CEA level and MMP-2 expression in BC tissue in poor prognosis group exhibited elevation relative to those in good prognosis group, and KiSS-1 expression in BC tissue in poor prognosis group exhibited depletion relative to that in good prognosis group, indicating statistical significance (P < 0.05). The high-level KiSS-1 might be a protective element for adverse prognosis of elderly BC patients after MCM, and high-level CEA and MMP-2 might be an independent risk element for adverse prognosis of elderly BC patients after MCM (P < 0.05). KiSS-1 and MMP-2 alone and jointly predicted AUC of adverse prognosis in elderly BC patients after MCM were 0.93, 0.802 and 0.958, with certain predictive values; when cutoff values of KiSS-1 and MMP-2 were 6.15 and 2.26, the predictive value was the best. In conclusion, KiSS-1 and MMP-2 levels in BC tissue possess relation to adverse prognosis of MCM. KiSS-1 and MMP-2 levels in elderly BC patients before surgery may be detected in the future to assist in prognosis evaluation of elderly BC patients after MCM.

2020 Annual Report of National Clinical Database-Breast Cancer Registry: 10-year mortality of elderly breast cancer patients in Japan.

The Japanese Breast Cancer Society initiated the breast cancer registry in 1975, which transitioned to the National Clinical Database-Breast Cancer Registry in 2012. This annual report presents data from 2020 and analyzes the ten-year mortality rates for those aged 65 and older. We analyzed data from 93,784 breast cancer (BC) cases registered in 2020 and assessed 10-year mortality rates for 36,279 elderly patients diagnosed between 2008 and 2012. In 2020, 99.4% of BC cases were females with a median age of 61. Most (65%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery rates varied with stages: 58.5% at cStage I, 30.8% at cStage II, and 13.1% at cStage III. Sentinel lymph node biopsy was done in 73.6% of cases, followed by radiotherapy in 70% of those post-conserving surgery and chemotherapy in 21.1% post-surgery. Pathology showed that 63.4% had tumors under 2.0cm, 11.7% had pTis tumors, and 77.3% had no axillary lymph node metastasis. ER positivity was seen in 75.1%, HER2 in 14.3%, and 30% had a Ki67 positivity rate above 30%. Across all stages and subtypes, there was a trend where the 10-year mortality rates increased for individuals older than 65years. In Stage I, many deaths were not directly linked to BC and, for those with HER2-type and triple-negative BC, breast cancer-related deaths increased with age. Within Stage II, patients older than 70years with luminal-type BC often experienced deaths not directly linked to BC, whereas patients below 80years with HER2-type and triple-negative BC, likely had breast cancer-related deaths. In Stage III, breast cancer-related deaths were more common, particularly in HER2 and triple-negative BC. Our prognostic analysis underscores distinct mortality patterns by stage, subtype, and age in elderly BC patients. It highlights the importance of personalized treatment strategies, considering subtype-specific aggressiveness, age-related factors, and comorbidities.

Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment.

Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ~60% of deaths from BC occur in women aged 70 years and older. Only limited data are available on the prognostic impact of age according to treatment, especially in the triple-negative (TN) and Her2-positive because of the lower frequency of these subtypes in elderly patients. We report herein the results of a multicenter retrospective study analyzing the prognostic impact of age according to treatment delivered in TN and Her2-positive BC patients of 70 years or older, including comparison by age groups. The medical records of 31,473 patients treated from January 1991 to December 2018 were retrieved from 13 French cancer centers for retrospective analysis. Our study population included all ≥70 patients with TN or Her2-positive BC treated by upfront surgery. Three age categories were determined: 70-74, 75-80, and > 80 years. Of 528 patients included, 243 patients were 70-74 years old (46%), 172 were 75-80 years (32.6%) and 113 were >80 years (21.4%). Half the population (51.9%, 274 patients) were TN, 30.1% (159) Her2-positive/hormone receptors (HR)-positive, and, 18% (95) Her2-positive/endocrine receptors (ER)-negative BC. Advanced tumor stage was associated with older age but no other prognostic factors (tumor subtype, tumor grade, LVI). Adjuvant chemotherapy delivery was inversely proportional to age. With 49 months median follow-up, all patient outcomes (overall survival (OS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS)) significantly decreased as age increased. In multivariate analysis, age >80, pT2-3 sizes, axillary macrometastases, lymphovascular involvement, and HR-negativity tumor negatively affected DFS and OS. Comparison between age >80 and <=80 years old showed worse RFS in patients aged > 80 (HR=1.771, p=0.031). TN and Her2-positive subtypes occur at similar frequency in elderly patients. Older age is associated with more advanced tumor stage presentation. Chemotherapy use decreases with older age without worse other pejorative prognostic factors. Age >80, but not ≤80, independently affected DFS and OS.

The trade-off of post-mastectomy radiotherapy usage for the breast cancer patients aged 70 years or older: a study based on SEER database

BackgroundThis study aimed to investigate the role of post-mastectomy radiotherapy (PMRT) in the female aged 70 years or older diagnosed with breast cancer, which is still controversial.MethodsThis retrospective study enrolled female breast cancer women aged 70 + years following mastectomy from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce covariable imbalance. A nomogram was created to predict the 1,3,5-years overall survival (OS) and divide patients into three risk groups.ResultsAfter matching, PMRT were associated with significant improvement in breast cancer-specific survival (BCSS) and OS (p < 0.001). By contrast, the BCSS and OS benefit from PMRT were not significant in patients with T1N1 tumor (BCSS: HR = 0.716, p = 0.249;OS:HR = 0.908, p = 0.572), and T2N1 tumor (BCSS:HR = 0.866, p = 0.289;OS:HR = 0.879, p = 0.166). Stratified by subtype, the HR+/HER-2- subtype and the HR-/HER-2- subtype (all p < 0.001) have a significant prolonged survival, yet not significant BCSS difference are shown in the HER-2 + tumor. In the low-risk group as determined by the nomogram, the use of PMRT did not significantly improve OS (p = 0.203).ConclusionsThis study demonstrated that PMRT improves the survival of females with elderly breast cancer, while for T1-2N1 breast cancer patients, the omission of PMRT could be considered. Furthermore, the nomogram we constructed could be used as a decision tool for the omission of PMRT in low-risk elderly patients.

Surgical choices and complications in elderly women: a single center retrospective analysis in frail vs. non frail breast cancer patients

BackgroundEarly breast cancer (EBC) in the elderly is a major public health problem and a risk factor for undertreatment. The authors aim to describe surgical patterns and outcomes of an elderly population diagnosed with EBC treated in a BC-dedicated reference center.Methods Retrospective study for all EBC patients ≥70 years old submitted to breast surgery from 2018 to 2021. Patients were included if submitted to the G8 screening tool. Data on standard demographics, surgery performed, and outcomes were collected.ResultsOverall, 192 patients were included. Frail patients were significantly older (p<0.01), had worse Charlson Comorbidity Index (p<0.01) and ASA (p<0.01) scores and more comorbidities (p=0.09). In total, 199 breasts were operated; 173 breast conservative surgeries (BCS) and 26 mastectomies. In the frail population, oncoplastic surgery after BCS was more frequently mammoplasty; no reconstruction was reported after mastectomy. In the fit group, more diversity was seen in oncoplastic procedures; 13 breasts underwent direct-to-implant breast reconstruction (BR) after mastectomy. Frail patients were less likely to be offered BR (p<0.01). There was no association between frailty and postoperative complications, in-hospital length of stay, readmission, or reintervention.ConclusionsOur results suggest that G8 frail patients are less likely to be offered BR. Even if there were no significant differences in surgical adverse outcomes between groups, this could have been masked by a higher proportion of BR among fit patients. G8 screening can be a useful instrument to support the surgeon’s decision to whether or not to consider BR in elderly breast cancer patients.Level of Evidence: Level IV, Risk/Prognostic Study.

Characteristics and prognosis of adolescent and young adult breast cancer.

16 Background: Adolescent and young adult (AYA)-generation breast cancer has characteristics of high clinicopathological malignancy and poor prognosis compared to cancers of other age groups. In recent advances in cancer research, the tumor microenvironment is involved in cancer invasion. In this study, we investigated the biology of AYA-generation breast cancer and the prognostic effects of the cancer microenvironment in breast cancer patients. Methods: In the current study, we analyzed 2042 breast cancer patients with clinical and intratumoral gene expression data from the open public databases TCGA and METABRIC. Patients aged 15-39 were defined as AYA-generation breast cancer, and patients aged 40-65 as middle-aged breast cancer. Tumor biology and cancer microenvironment were assessed using gene set enrichment analysis (GSEA) and the xCell algorithm. Disease-specific survival (DSS) and disease-free survival (DFS) were used to evaluate the prognosis of AYA-generation breast cancer compared to that of middle-aged and elderly breast cancer. Results: In METABRIC, the proportion of advanced stages was higher in AYA generation breast cancer than in middle-aged and elderly breast cancer (p&lt;0.01). However, this was not the case with TCGA cohort. In the prognostic analysis, AYA-generation breast cancer showed shortened DSS and DFS compared with middle-aged breast cancer only in METABRIC. To clarify the association between prognosis and cancer biology, we performed GSEA. AYA-generation breast cancer enriched cell proliferation-related gene sets such as E2F Targets, G2M Checkpoints, and MYC Targets V1 in METABRIC. The analysis of TCGA also confirmed this result. Interestingly, the infiltration of macrophage M1 (p&lt;0.001) and helper T cell Th1 (p=0.007), which act as tumor suppressors, was significantly higher in AYA generation breast cancer in METABRIC cohort. In TCGA, there was only a tendency for Th1 infiltration to be high in AYA generation breast cancer. Conclusions: AYA-generation breast cancer enriched gene sets associated with cell proliferation which might explain the worse prognosis of AYA-generation breast cancer.

Mediation of race/ethnicity (R/E) disparities in mental health patient reported outcomes (PROS) among elderly female patients with breast cancer (BC) in the Surveillance, Epidemiology, and end results-medicare health outcomes survey (SEER-MHOS) database.

e22527 Background: Variations in mental health PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbid disease (CD), tumor biology (TB), social support (SS), and treatment factors (TF). We examine the extent to which the R/E disparity in patient reported mental health summary scores (MCS) is transmitted through these domains. Methods: Data is from SEER-MHOS and the analytic sample (n = 17,465) included 12,493 NHW, 2,503 NHB, and 2,019 Hispanic women with newly diagnosed BC between 2010-2017. MCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins (risk difference %) to evaluate crude and age/body mass index (BMI)-adjusted MCS by R/E and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of (1) SEP [household income (&lt; 30K, 30K-80K, &gt; 80K) and education attainment [ &lt; High School (HS), HS, &gt; HS)]; (2) CD [smoking status (current smoker/current non-smoker), diabetes (yes/no), and hypertension (yes/no)]; (3) TB [stages (1-3), grade (well/moderate/poor), and subtype (luminal A/ triple negative)]; (4) SS [domestic partner (yes/no); and (5) TF [systemic therapy (yes/no)]. Results: Overall, NHB and Hispanic women were younger and had higher BMI than NHW women and crude models showed MCS disparity for NHBs (-4.13%; 95% CI: -4.63, -3.63) and Hispanics (-5.91%, 95%CI: -6.49, -5.34) compared with NHWs. In baseline age/BMI adjusted models, NHBs and Hispanics had worse MCS, -3.78% (95% CI: -3.2, -4.35) and -5.7% (95% CI: -5.04, -6.36) respectively, compared with NHWs. Control for TF had minimal effect on the observed disparity [NHB (-3.85%; 95% CI: -4.56, -3.15) and Hispanics (-4.79%; 95% CI: -5.6, -3.97) compared with NHW], but control for SEP largely reduced the disparity [NHB (-1.56%; 95% CI: -0.89, -2.23) and Hispanics (-2.8%; 95% CI: -1.99, -3.6)]. Inclusion of all 5 domains also attenuated the magnitude of the disparity to a degree such that it was still considered a minimally important difference for Hispanics (-2.34%, 95% CI: -3.75, -0.94), but not for NHBs (0.12%; 95% CI: -1.08, 1.32). However, low acculturation in Hispanics appeared to modify (worsen) the disparity. Based on the method of RC, we determined that SEP accounted for the largest fraction of mediated effects. Conclusions: Our findings suggest that observed R/E differences in mental health PROs in elderly BC patients are largely mediated by differences in SEP rather than treatment.

Abstract C113: Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database

Abstract Objective: Variations in physical PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbidities, and tumor biology (TB). We examine the extent to which the race/ethnicity disparity in patient reported physical component score (PCS) is transmitted through these domains. Methods: Data is from the Surveillance, Epidemiology, and End Results- Medicare Health Outcomes Survey dataset (SEER-MHOS) which is used to research health outcomes in cancer patients. The analytic sample (n=19,857) included 14,936 NHW, 2,897 NHB, and 2,024 Hispanic women with newly diagnosed BC between 2010-2017. PCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins to evaluate crude and age/body mass index (BMI)-adjusted PCS by race/ethnicity and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of SEP [household income (&amp;lt; 30K, 30K-80K, &amp;gt;80K) and education attainment [&amp;lt;High School (HS), HS, &amp;gt;HS)], comorbidities [smoking status (current smoker/current non-smoker), diabetic (yes/no), and hypertensive (yes/no)], and tumor biology [stage(1-3), grade (well/moderate/poor), and subtype (luminal A/triple negative)]. Results: Overall, NHB and Hispanic women were younger and had a higher BMI than NHW women. In baseline age/BMI adjusted models, NHWs had PCSs 3.4 points significantly higher than both NHWs and Hispanics (95% CI: 2.8, 3.9 and 2.8, 4.1, respectively). Adjusting for SEP reduced the observed disparity: NHB (1.6; 95% CI: 0.90, 2.3) and Hispanics (0.76; 95% CI: 0.04, 1.6) compared to NHW. Inclusion of all three domains highly attenuated the observed PCS disparities between the minority populations and NHWs (0.20; 95%CI: -1.1, 1.5) for NHB and (0.54; 95%CI: -0.90, 1.99) for Hispanics compared to NHWs]. Based on the method of RC, we determined the SEP accounted for the largest fraction of mediated effects, followed by comorbidities, with TB having the smallest effect. Conclusion: Our findings support the hypothesis that observed racial/ethnicity differences in physical PROs in elderly BC patients are largely mediated by differences in SEP and comorbidity, rather than TB. Citation Format: Kristen E. Champion, Kendra Krebsbach, Chloe Stallion, Keith A. Dookeran. Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C113.

Risk assessment of disease recurrence in early breast cancer: A serum metabolomic study focused on elderly patients

BackgroundWe previously showed that metabolomics predicts relapse in early breast cancer (eBC) patients, unselected by age. This study aims to identify a “metabolic signature” that differentiates eBC from advanced breast cancer (aBC) patients, and to investigate its potential prognostic role in an elderly population. MethodsSerum samples from elderly breast cancer (BC) patients enrolled in 3 onco-geriatric trials, were retrospectively analyzed via proton nuclear magnetic resonance (1H NMR) spectroscopy. Three nuclear magnetic resonance (NMR) spectra were acquired for each serum sample: NOESY1D, CPMG, Diffusion-edited. Random Forest (RF) models to predict BC relapse were built on NMR spectra, and resulting RF risk scores were evaluated by Kaplan–Meier curves. ResultsSerum samples from 140 eBC patients and 27 aBC were retrieved. In the eBC cohort, median age was 76 years; 77% of patients had luminal, 10% HER2-positive and 13% triple negative (TN) BC. Forty-two percent of patients had tumors >2 cm, 43% had positive axillary nodes. Using NOESY1D spectra, the RF classifier discriminated free-from-recurrence eBC from aBC with sensitivity, specificity and accuracy of 81%, 67% and 70% respectively. We tested the NOESY1D spectra of each eBC patient on the RF models already calculated. We found that patients classified as "high risk" had higher risk of disease recurrence (hazard ratio (HR) 3.42, 95% confidence interval (CI) 1.58–7.37) than patients at low-risk. ConclusionsThis analysis suggests that a “metabolic signature”, identified employing NMR fingerprinting, is able to predict the risk of disease recurrence in elderly patients with eBC independently from standard clinicopathological features.

Abstract 5867: Examination of race/ethnicity differences in patient reported outcomes (PROs) among elderly female breast cancer patients in the SEER-MHOS database

Abstract We use regression models to examine baseline differences in physical and mental health PROs [Physical and Mental Component Summary T-scores (PCS/MCS: are linear transformations of the 0-100 possible range scoring for 8 SF-36/VR-12 sub-scales, with mean of 50 and standard deviation (SD) of 10, normed to the US population)] among non-Hispanic black (NHB), non-Hispanic white (NHW), and Hispanic elderly female patients, with newly diagnosed breast cancer (BC) between 2010-2015 in the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) database (a cancer registry that provides value health-related quality of life information on patients enrolled in Medicare Advantage). The study analytic sample consisted of 11,765 NHW, 1,988 NHB and 1,361 Hispanic women with overall mean age and BMI of 50.1 years (SD: 10.5) and 27.5 kg/m^2 (SD: 6.6), respectively. Compared with NHW both NHB and Hispanic women had significantly elevated BMI [NHB risk difference (RD) 3.43, 95% CI: 3.09, 3.77; Hispanic RD 0.84, 95% CI: 0.44, 1.24]; but significantly lower age at diagnosis [NHB RD -2.86, 95% CI: -3.36, -2.37; Hispanic RD -1.67, 95% CI: -2.26, -1.09]. Compared with NHW, both crude PCS and MCS scores were significantly worse for NHB and Hispanic women [PCS: NHB RD -4.26, 95% CI: -4.87, -3.65; Hispanic RD -3.29, 95% CI: -4.01, -2.56; MCS: NHB RD -3.79, 95% CI: -4.37, -3.22; Hispanic RD -4.09, 95% CI: -4.76, -3.43]. These differences also persisted after adjustment for BMI and age [compared with NHW, PCS: NHB RD -2.09, 95% CI: -2.76, -1.43; Hispanic RD -3.26, 95% CI: -4.06, -2.45; MCS: NHB RD -3.2, 95% CI: -3.86, -2.54; Hispanic RD -4.21, 95% CI: -4.99, -3.43]. There were however no significant differences in PCS or MCS scores between NHB and Hispanic women after adjustment for age and BMI. Our results show that elderly NHB and Hispanic women with BC in the SEER-MHOS database are significantly more likely to have poorer physical and mental outcomes compared with NHW. However, this PRO disparity was not evident between NHB and Hispanic women and requires further exploration. Citation Format: Kendra R. Krebsbach, Chloe L. Stallion, Keith A. Dookeran. Examination of race/ethnicity differences in patient reported outcomes (PROs) among elderly female breast cancer patients in the SEER-MHOS database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5867.

Treatment results and patient characeristics for breast cancer patients older than 70 Years

Objective: The incidence of breast cancer (BC) subtypes varies according to age, and its treatment is more strenuous and requires much more attention in advanced ages. The aim of this study is to investigate patient characteristics and treatment results respectively for patients older than 70 years. Materials and Methods: In this study, we examined 188 elderly BC patients treated in our hospital, at March 2008 - November 2019. Patient characteristics and demographics were investigated from patients’ files retrospectively. Results: Mean age of the patients was 74.3 ± 4 years (All female). The presence of comorbid diseases was 76.1%. Major histology was invasive ductal carcinoma in 72.9% and mostly grade 2 differentiated, and the majority of patients were T2 size (58.5%). Oestrogen receptor (OR) positivity was seen in 83%, Progesterone receptor (PR) positivity in 72.3% of patients and cerb2 positivity in 16.5%. Luminal B (47.9%) was the most common in molecular subgroup analysis. Patients with lymph node involvement (N1 33%; N2, 19.1%; N3, 6.9%) were higher than those without involvement (34%). Surgery type was modified radical mastectomy (MRM) for 51.6%, breast conserving surgery (BCS) for 39.4 % and lumpectomy for 7.4%. In a median follow-up time was 53.9 (9-101) months, local recurrence was seen in 5 (2.7%) patients and distant metastasis was developed in 16 (8.5%) patients. The median overall survival was worse in those with MRM than those with BSC (p=0.006). In multivariate logistic regression analysis, only found that lymph node positivity was an independent risk factor for metastasis (HR; 4.15, 95% CI:1.019-16.933, P=0.047). Conclusion: While it was observed that the most important risk factor for metastasis risk in elderly patients was lymph node positivity; The hormonal status and her2 conditions were not affected in terms of metastasis. It was thought that tumor clinical course and relapse may differ in the elderly population compared to general BC patients.

Abstract P1-12-04: The impact of chemotherapy in elderly early triple negative breast cancer: A population based study from the SEER database

Abstract Introduction: The management of senile breast cancer is still controversial, especially chemotherapy. Therefore, we conduct an analysis of the impact of chemotherapy and establish prediction models of prognosis in elderly early TNBC by using machine learning. Methods: We enrolled 4,696 patients from SEER database according to the following criteria: female; year of diagnosis from 2010 to 2016; age of diagnosis ≥ 70 years; invasive ductal carcinoma as the only primary malignant cancer; stage I-III; TNBC subtype. The PSM method was utilized to reduce covariable imbalance. Univariable and multivariable analyses were used to compare BCSS and OS. KNN, CatBoost, decision tree, random forest, Gradient Boost, LightGBM, neural network models, SVM, XGBoost and logistic regression models were developed to predict the 5-year OS and BCSS for patients in the chemotherapy group. Results: Compared to matched patients with no-chemotherapy, multivariate analysis showed a better survival in matched patients with chemotherapy(BCSS:HR = 0.594,95%CI = 0.479-0.737,p &amp;lt; 0.001; OS:HR = 0.532,95%CI = 0.446-0.635,p &amp;lt; 0.001). Stratified analyses by age and stage was also conducted to discriminate the patients benefited from chemotherapy. Chemotherapy didn’t lowered the risk of cancer-specific mortality and all-cause mortality in stage I cohort (70-79 years, BCSS, HR=1.058, 95% CI=0.609-1.838, p=0.841; OS HR=0.721, 95% CI=0.478-1.086, p=0.117; 80+ years, BCSS, HR=0.210, 95% CI=0.005-8.920, p=0.414; OS HR=0.458, 95% CI=0.048-3.918, p=0.458). But patients diagnosed with stage II can benefit from chemotherapy (70-79 years, BCSS, HR=0.628, 95% CI=0.424-0.932, p=0.021; OS HR=0.538, 95% CI=0.386-0.749, p&amp;lt;0.001; 80+ years, BCSS, HR=0.413, 95% CI=0.230-0.744, p=0.003; OS HR=0.416, 95% CI=0.260-0.667, p&amp;lt;0.001). We observed similar phenomena in the stage III cohort. We further investigated the effects of tumor and nodal status in stage II cases between the two groups. We found that chemotherapy was a better prognostic indicator for patients with T2N0M0 and stage IIb (T2N0M0, BCSS, HR=0.420, 95% CI=0.261-0.675, p&amp;lt;0.001; OS HR=0.0.361, 95% CI=0.243-0.536, p&amp;lt;0.001; stage IIb, BCSS, HR=0.752, 95% CI=0.454-1.246, p=0.269; OS HR=0.640, 95% CI=0419-0.978, p=0.039), but not for T1N1M0 (BCSS, HR=0.778, 95% CI=0.249-2.432, p=0.666; OS HR=1.072, 95% CI=0.458-2.508, p=0.872). For patients with grade I and II, no statistical survival differences were identified between chemotherapy and no-chemotherapy patients(BCSS, HR=0.781, 95% CI=0.445-1.368, p=0.387; OS HR=0.802, 95% CI=0.512-1.256, p=0.335). While for patients with grade III, the chemotherapy patients demonstrated a better prognosis than no-chemotherapy patients (BCSS, HR=0.558, 95% CI=0.440-0.707, p&amp;lt;0.001; OS, HR=0.492, 95% CI=0.405-0.599, p&amp;lt;0.001). Ten models mentioned above were conducted to predict the 5-year OS and BCSS for patients in the chemotherapy group. On average, the accuracy was 0.885 on 5-year BCSS and 0.858 on 5-year OS. The average precision of the examined ten algorithms was 0.880 on 5-year BCSS and 0.862 on 5-year OS. Similarly, the average sensitivity was 0.981 on 5-year BCSS and 0.971 on 5-year OS. There was average F1 score of 0.932 on 5-year BCSS and 0.913 on 5-year OS. In terms of the AUC, the highest AUC was observed for the LightGBM. Considering all the parameters above, the LightGBM outperformed all other algorithms. Conclusion: For stage I, T1N1M0, grade I and grade II elderly early triple negative invasive ductal carcinoma patients, chemotherapy could not improve OS and BCSS. Therefore, de-escalation therapy might be appropriate for selected patients. The LightGBM is practical and trustful to predict the 5-year OS and BCSS for patients in the chemotherapy group. Citation Format: KaiYan Huang, Jie Zhang, YuShuai Yu, YuXiang Lin, ChuanGui Song. The impact of chemotherapy in elderly early triple negative breast cancer: A population based study from the SEER database [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-12-04.

Abstract P3-19-26: The impact of post-mastectomy radiotherapy on the survival of breast cancer patients aged 70 years or older: A study based on SEER database

Abstract The impact of post-mastectomy radiotherapy on the survival of breast cancer patients aged 70 years or older: a study based on SEER databaseIntroduction: This study aimed to investigate the role of post-mastectomy radiotherapy (PMRT) in the female aged 70 years or older diagnosed with breast cancer, which is still controversial.Methods: This retrospective study extracted data from the Surveillance, Epidemiology, and End Results (SEER) database. Women aged 70 years or more diagnosed with breast cancer between 2004 and 2016 following mastectomy were enrolled. Propensity score matching (PSM) was performed to reduce covariable imbalance. The univariable and multivariable analyses calculated the prognostic factors. Kaplan-Meier survival curves and multivariable Cox regression model were applied to compare breast cancer-specific survival (BCSS) and overall survival (OS) between two arms and among subgroups stratified by various clinicopathological factors. Results: Of the 27,636 female were eligible, 17.2%(n=4,747) received PMRT while 82,8%(n=22,889) not. By multivariable Cox analysis, radiotherapy was still founded to be independent prognostic factors for BCSS and OS. After 1:1 matching, PMRT were associated with significant improvement in BCSS and OS(p &amp;lt;0.001). By contrast, the BCSS and OS benefit from PMRT were not statistically significant in patients with T1 tumor and 1-3 positive lymph nodes(BCSS:HR = 0.716,95%CI 0.406-1.263,p = 0.249;OS:HR = 0.908,95%CI 0.648-1.270,p = 0.572), and the results were consistent in patients with T2 tumor and 1-3 positive lymph nodes(BCSS:HR = 0.866,95%CI 0.664-1.130,p = 0.289;OS:HR = 0.879,95%CI 0.732-1.055,p = 0.166). Stratified by grade, number of positive lymph nodes, and HR status, there were still not survival advantage of PMRT observed for patients with T1-2N1 breast cancer(all p&amp;gt;0.05).Conclusions: This study demonstrates that post-mastectomy radiotherapy has a definite role in improving the survival of females with elderly breast cancer. After a comprehensive assessment of the side effects and the quality of life, the omission of PMRT could be considered in patients with T1-2N1 breast cancer. Citation Format: Jingyi Lin, Shiping Luo, Jie Zhang, Chuangui Song. The impact of post-mastectomy radiotherapy on the survival of breast cancer patients aged 70 years or older: A study based on SEER database [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-26.

Development and Validation of Prognostic Nomogram for Elderly Breast Cancer: A Large-Cohort Retrospective Study.

PurposeOur research aims to study the bone metastatic patterns and prognostic outcomes in elderly breast cancer (BC) and to develop elder-specific nomograms.MethodsWe downloaded the data of BC patients between 2010 and 2016 from the Surveillance, Epidemiology, and End Results database. The differences in clinical features and prognosis between young (age < 65) and elderly (age ≥ 65) BC patients were compared. The univariate and multivariate Cox analyses were used to determine the overall survival (OS)- and cancer-specific survival (CSS)-related variables and establish two nomograms of BC patients with bone metastasis (BCBM). The receiver operating characteristic (ROC) curve with area under the curve (AUC), calibration curve, decision curve analysis (DCA), and Kaplan–Meier survival curve were selected to evaluate nomograms.ResultsA total of 230,177 BC patients were enrolled in our research, including 142,025 young and 88,152 elderly patients. The prognosis of elderly BCBM patients was significantly worse than young patients. Age, race, breast subtype, tumor size, tumor grade, brain metastasis, liver metastasis, surgery, and chemotherapy were independent prognostic variables for elderly BCBM patients, including OS and CSS. The AUC values at 12, 18, and 24 months were 0.750, 0.751, and 0.739 for OS nomogram and 0.759, 0.762, and 0.752 for CSS nomogram in the training cohort, which were higher than the AUC values of all single independent prognostic variables. The survival curve showed a distinct prognosis between low-, median- and high-risk groups (p < 0.001). Finally, calibration curves and DCA indicated that both nomograms have favorable performance.ConclusionElderly and young patients presented with different bone metastatic frequencies, clinical features, and prognostic outcomes. Two elder-specific nomograms incorporating nine clinical variables were established and validated to be a valuable predictor for elderly BCBM patients.

Impact of diabetes and other comorbidities on cardiovascular mortality in elderly breast cancer patients

Breast cancer (BC), like most cancer, is a disease of aging. According to the Surveillance Epidemiology and End Results registry, the median age of BC diagnosis is 62 with 40% > 65 years, among whom 16% additionally suffer from diabetes mellitus (DM). As survival time increases with more effective treatment, CVD risk factors (CVDRF) are now increasing in this aging population. The aim of this study was to assess the impact of DM and other CVDRF on cardiovascular disease (CVD) mortality in elderly BC patients. This retrospective study included women aged > 55 who were initially diagnosed with BC recruited from the registry of the cardio-oncology unit of Casablanca, Morocco, from January 2014 to March 2021. Patients were divided into 4 categories: no comorbidity, DM only, DM and other comorbidity or other comorbidity without DM. Overall, 1843 patients with non-metastasized BC were included. Mean age of our series was 61.3 years, comorbidities at baseline prior to BC were: hypertension in 19.3%, DM in 9.8%, dyslipidemia in 11.8% and obesity in 10.4%. In our series, the short-term Overall survival (OS) was higher in patients with DM only compared with patients without comorbidity (HR: 1.16, 95% CI: 0.85–1.88) ( P = 0.037) and similar with those with other comorbidity without DM (HR: 0.76, 95% CI: 0.48–0.92) ( P = 0.066), while patients with DM and additional comorbidity had the worst short-term OS (HR: 1.82, 95% CI: 1.54–2.16) ( P < 0.001) especially in patients aged ≥ 75 years ( P = 0.028). In our study, among elderly BC patients, diabetes mellitus is associated with poorer prognosis and shorter OS compared to patients without any comorbidity, especially if associated with additional comorbidities such as hypertension, dyslipidemia and obesity. Larger registries to better understand the true incidence of CVD and the utility of current treatments would be invaluable for this growing population of breast cancer survivors.

Development of a novel five-lncRNA prognostic signature for predicting overall survival in elderly patients with breast cancer.

BackgroundBreast cancer (BC) is an age‐related disease. Long noncoding RNAs (lncRNAs) have been proven to be crucial contributors in tumorigenesis. This study aims to develop a novel lncRNA‐based signature to predict elderly BC patients’ prognosis.MethodsThe RNA expression profiles and corresponding clinical information of 182 elderly BC patients were retrieved from The Cancer Genome Atlas (TCGA). Differentially expressed lncRNAs (DElncRNAs) between BC and adjacent normal samples were used to construct the signature in the training set through univariate Cox regression analysis, LASSO regression analysis, and multivariate Cox regression analysis. Kaplan–Meier analysis and time‐dependent receiver operating characteristic (ROC) analysis were used to evaluate the predictive performance. Besides, we developed the nomogram. Gene set enrichment analysis (GSEA) was performed to reveal the underlying molecular mechanisms.ResultsWe constructed the five‐lncRNA signature (including LEF1‐AS1, MEF2C‐AS1, ST8SIA6‐AS1, LINC01224, and LINC02408) in the training set, which successfully divided the patients into low‐ and high‐risk groups with significantly different prognosis (p = 0.000049), and the AUC at 3 and 5 years of the signature was 0.779 and 0.788, respectively. The predictive performance of this signature was validated in the test and entire set. The 5‐lncRNA signature was an independent prognostic factor of OS (p = 0.007) and the nomogram constructed by independent prognostic factors was an accurate predictor of predicting overall survival probability. Besides, several pathways associated with tumorigenesis have been identified by GSEA.ConclusionsThe 5‐lncRNA signature and nomogram are reliable in predicting elderly BC patients’ prognosis and provide clues for clinical decision‐making.

Is the oncotype DX test useful in elderly breast cancer patients: a subgroup analysis of real-life Italian PONDx study.

The 21-gene Oncotype DX Breast Recurrence Score® test, (Genomic Health, Redwood City CA) has not been formally evaluated in an older cohort with estrogen receptor (ER)-positive breast cancer (BC) in term of physicians' treatment decisions. We determine the utility of Recurrence Score® (RS) result on adjuvant therapy prescription in elderly patients with resected early BC. PONDx was a multicenter, prospective, observational study, and which investigated the real-life use of the Oncotype DX® test by physicians treating early BC patients in clinical practice. Data from the elderly extracted from 1724 BC patients who underwent Oncotype DX testing were available from 27 reference centers located in 6 regions of Italy (Lombardia, Lazio, Emilia Romagna, Campania, Abruzzo, and Marche). A total of 230 patients (13% of the total population) aged > 70years were analyzed. The study primarily evaluated the impact of the Oncotype DX test on adjuvant treatment decisions. Physicians chosen chemotherapy plus endocrine therapy in 36% of elderly patients and 46% of those 50-70years before the Oncotype DX test. After knowing the RS data, these rates fell to 23 and 33% (38 and 28% relative reduction, respectively). 21-gene test may be helpful even in a relatively low-risk group as elderly patients and may avoid the toxicity of adjuvant chemotherapy in a significant amount. If the Oncotype DX test is currently adopted on a large scale among the elderly and may impact the general prognosis of elderly BC patients, it is challenging and still unproven.

Correlation between Age and Prognostic Factors in Thai Breast Cancer Women: A Single Institute Analysis

Background: Breast cancer is the most common cancer in females, especially for those in their middle age between 40 to 60 years. There are prognostic factors of breast cancer such as an intrinsic subtype called triple-negative breast cancer (TNBC), HER2 overexpression, poorly differentiated, large tumor size, axillary lymph node status, and staging. Age at diagnosis is usually associated with aggressive cancer and poorer outcomes. Objective: To explore the age and prognostic factors for breast cancer in Thailand. Materials and Methods: The data were collected from pathological data collection and medical records of Buddhasothorn Hospital, Chachoengsao, Thailand, between 2015 and 2018. All data were collected for studying the relationship between age at diagnosis and prognostic factors. Results: Three hundred three cases were collected. It was found that the age between 35 to 69 years had breast cancer the most (83.83%). The intrinsic subtypes found were Hormonal receptor-positive (HR+) 67.33%, TNBC 22.11%, and HER2 overexpression 10.56%. Age under 35 years had a risk of poor prognostic factors such as poorly differentiated (OR 1.528, 95% CI 0.306 to 7.627, p=0.605), large tumor size greater than 5 cm (OR 2.145, 95% CI 0.560 to 8.221, p=0.266), and axillary lymph node metastasis (OR 1.409, 95% CI 0.345 to 5.762, p=0.633). Age of 70 years and over had more favorable prognostic factors such as well-differentiated (OR 1.691, 95% CI 0.645 to 4.436, p=0.286), no axillary lymph node metastasis (OR 1.734, 95% CI 0.886 to 3.393, p=0.108), and the HR+ subtype (OR 2.158, 95% CI 0.954 to 4.882, p=0.065). Nonetheless, the present study data did show statistical significance. Conclusion: The evidence of breast cancer in Thailand found that the different age ranges affected the prognostic factors differently. Specifically, young age breast cancer had a higher risk of poor prognostic factors, whereas the elderly breast cancer was associated with more favorable prognostic factors. However, a larger number of patient data to the confirm relationship between age and prognostic factors is required. Keywords: Breast cancer; Age-related; Prognostic factors