Age and comorbidity in relation to treatment and survival outcomes in triple-negative breast cancer: A Swedish nationwide registry-based study

IF 3 3区医学 Q3 GERIATRICS & GERONTOLOGY

Journal of geriatric oncology Pub Date : 2025-05-08 DOI:10.1016/j.jgo.2025.102255

Jenny Nyqvist-Streng , Josef Somi , Jari Martikainen , Maxim Olsson , Khalil Helou , Chaido Chamalidou , Anikó Kovács , Toshima Z. Parris

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Abstract

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.

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年龄和合并症与三阴性乳腺癌治疗和生存结果的关系：瑞典一项基于登记的全国性研究

患有癌症和合并症的患者通常经历较长的诊断时间和明显较差的临床结果。在这里，我们评估了年龄、Charlson合并症指数（CCI）、给予的治疗和患者生存之间的关系，从而确定了三阴性乳腺癌（TNBC）患者常见的非乳腺癌相关死亡原因。材料和方法检索瑞典2007年至2021年间诊断为原发性侵袭性TNBC的患者的基于人群的登记数据（n = 7145）。对疾病特异性生存率进行多变量Cox回归分析，并使用诊断后6个月的里程碑时间（可能开始治疗的时间框架）计算总生存率。计算了年龄、合并症和治疗的多变量logistic回归模型。加权CCI （CCIw）分为CCIw 0、CCIw 1-3和CCIw 4-10。结果约42%的患者年龄≥65岁，30%有合并症（CCIw 1-3占27%，CCIw 4-10占3%）。≥65岁的患者常见两种或两种以上合并症。CCIw 4-10组的患者明显年龄较大（CCIw 1-3组为72岁，CCIw 1-3组为68岁，CCIw 0组为58岁），并且有局部扩散和较大的肿瘤。有合并症的患者接受新辅助化疗、保乳手术或术后治疗的可能性较小，且因非乳腺癌相关原因死亡的风险较高。≥75岁的患者在里程碑时间后8年内乳腺癌相关死亡的风险较高，此后因其他原因死亡的风险较高。此外，年龄较大（≥75岁）和有合并症的患者的5年生存率最低。其他肿瘤(26%；例如，肺癌、胰腺癌和卵巢癌)和心血管疾病（24%）是非乳腺癌相关死亡的主要原因，特别是在年龄≥50岁的患者中。患有三阴癌和合并症的患者不太可能接受特定的治疗方式，并且经历更差的生存结果。其他恶性肿瘤是50岁以上患者死亡的主要原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of geriatric oncology ONCOLOGY-GERIATRICS & GERONTOLOGY

CiteScore

5.30

自引率

10.00%

发文量

379

审稿时长

80 days

期刊介绍： The Journal of Geriatric Oncology is an international, multidisciplinary journal which is focused on advancing research in the treatment and survivorship issues of older adults with cancer, as well as literature relevant to education and policy development in geriatric oncology. The journal welcomes the submission of manuscripts in the following categories: • Original research articles • Review articles • Clinical trials • Education and training articles • Short communications • Perspectives • Meeting reports • Letters to the Editor.