Journal of geriatric oncology · 2025
Age and comorbidity in relation to treatment and survival outcomes in triple-negative breast cancer: A Swedish nationwide registry-based study.
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Nyqvist-Streng Jenny, Somi Josef, Martikainen Jari, Olsson Maxim, Helou Khalil, Chamalidou Chaido, Kovács Anikó, Parris Toshima Z
Аннотация
INTRODUCTION: Patients with cancer and comorbidities often experience a longer time-to-diagnosis and significantly worse clinical outcomes. Here, we evaluate the association between age, Charlson Comorbidity Index (CCI), treatment given, and patient survival, thereby identifying common non-breast cancer-related causes of death in patients with triple-negative breast cancer (TNBC).
MATERIALS AND METHODS: Population-based registry data were retrieved for patients diagnosed with primary invasive TNBC in Sweden between 2007 and 2021 (n = 7145). Multivariable Cox regression analyses were performed for disease-specific survival and overall survival was calculated using a landmark time set at six months post-diagnosis, the likely timeframe for treatment initiation. Multivariable logistic regression models were computed for age, comorbidity, and treatment. Weighted CCI (CCIw) was stratified into CCIw 0, CCIw 1-3, and CCIw 4-10.
RESULTS: Approximately 42 % of patients were ≥ 65 years of age and 30 % had comorbidities (27 % CCIw 1-3 and 3 % CCIw 4-10). Two or more comorbidities were common in patients ≥65 years. Patients in the CCIw 4-10 group were significantly older (72 years vs. 68 years for CCIw 1-3 vs. 58 years for CCIw 0) and had locoregional spread and larger tumors. Individuals with comorbidities were less likely to receive neoadjuvant chemotherapy, breast-conserving surgery, or postoperative treatment, and had a higher risk of death due to non-breast cancer-related causes. Patients ≥75 years had a higher risk of breast cancer-related death up to eight years after the landmark time and death from other causes thereafter. Furthermore, older (≥75 years) and patients with comorbidities had the lowest five-year survival probabilities. Other neoplasms (26 %; e.g., lung, pancreas, and ovarian cancer) and cardiovascular disease (24 %) were the leading causes of non-breast-cancer-related death, particularly in patients ≥50 years of age.
DISCUSSION: Patients with TNBC and comorbidities are less likely to receive specific treatment modalities and experience worse survival outcomes. Other malignant neoplasms are the leading cause of death for patients ≥50 years of age.
MATERIALS AND METHODS: Population-based registry data were retrieved for patients diagnosed with primary invasive TNBC in Sweden between 2007 and 2021 (n = 7145). Multivariable Cox regression analyses were performed for disease-specific survival and overall survival was calculated using a landmark time set at six months post-diagnosis, the likely timeframe for treatment initiation. Multivariable logistic regression models were computed for age, comorbidity, and treatment. Weighted CCI (CCIw) was stratified into CCIw 0, CCIw 1-3, and CCIw 4-10.
RESULTS: Approximately 42 % of patients were ≥ 65 years of age and 30 % had comorbidities (27 % CCIw 1-3 and 3 % CCIw 4-10). Two or more comorbidities were common in patients ≥65 years. Patients in the CCIw 4-10 group were significantly older (72 years vs. 68 years for CCIw 1-3 vs. 58 years for CCIw 0) and had locoregional spread and larger tumors. Individuals with comorbidities were less likely to receive neoadjuvant chemotherapy, breast-conserving surgery, or postoperative treatment, and had a higher risk of death due to non-breast cancer-related causes. Patients ≥75 years had a higher risk of breast cancer-related death up to eight years after the landmark time and death from other causes thereafter. Furthermore, older (≥75 years) and patients with comorbidities had the lowest five-year survival probabilities. Other neoplasms (26 %; e.g., lung, pancreas, and ovarian cancer) and cardiovascular disease (24 %) were the leading causes of non-breast-cancer-related death, particularly in patients ≥50 years of age.
DISCUSSION: Patients with TNBC and comorbidities are less likely to receive specific treatment modalities and experience worse survival outcomes. Other malignant neoplasms are the leading cause of death for patients ≥50 years of age.