Effectiveness of adjuvant chemotherapy for node-positive operable breast cancer in older women

Xianglin L. Du, Dennie V. Jones, Dong Zhang

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Abstract

Background. Randomized clinical trials have shown the efficacy of adjuvant chemotherapy in treating node-positive operable breast cancer in women aged ≤69 years, but the benefit of chemotherapy in women aged ≥70 is questionable. This study was to examine if adjuvant chemotherapy is effective for these women with breast cancer. Methods. We studied a cohort of 5464 women diagnosed with node-positive operable breast cancer at age ≥65 in 1992 through 1996 with last follow-up of December 31, 1999 in five states and six metropolitan areas. Hazard ratio (HR) for all-cause mortality was used for survival analysis with adjustment for patient and tumor characteristics; propensity analysis was used to control for observed factors; and sensitivity analysis was used to estimate potential effects of unmeasured confounders. Results. After adjusting for propensity to receive chemotherapy, the chemotherapy-treated and untreated groups were not statistically significantly different for covariates except for age and hormone receptor status. Mortality was significantly reduced in women aged 65-69 who received adjuvant chemotherapy compared to those who did not, after adjusting for patient and tumor characteristics (HR = 0.70, 95% confidence interval [CI], 0.57-0.88) or after adjusting for propensity scores (HR = 0.76, 95% CI, 0.62-0.94). HR did not significantly differ between the treated and untreated women aged ≥70 (HR = 0.96, 95% CI = 0.83-1.09, and HR = 0.99, 95% CI, 0.87-1.14). These results were relatively insensitive to changes in unmeasured confounders. Conclusions. Adjuvant chemotherapy is associated with improved survival in women with node-positive operable breast cancer aged 65-69 living in the community, but not in women aged ≥70. These findings are consistent with those found in randomized controlled trials.

Original languageEnglish (US)
Pages (from-to)1137-1144
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume60
Issue number9
StatePublished - Sep 2005

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Adjuvant Chemotherapy
Breast Neoplasms
Confidence Intervals
Drug Therapy
Randomized Controlled Trials
Propensity Score
Mortality
Survival Analysis
Neoplasms
Hormones
Survival

ASJC Scopus subject areas

  • Aging

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Effectiveness of adjuvant chemotherapy for node-positive operable breast cancer in older women. / Du, Xianglin L.; Jones, Dennie V.; Zhang, Dong.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 60, No. 9, 09.2005, p. 1137-1144.

Research output: Contribution to journalArticle

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abstract = "Background. Randomized clinical trials have shown the efficacy of adjuvant chemotherapy in treating node-positive operable breast cancer in women aged ≤69 years, but the benefit of chemotherapy in women aged ≥70 is questionable. This study was to examine if adjuvant chemotherapy is effective for these women with breast cancer. Methods. We studied a cohort of 5464 women diagnosed with node-positive operable breast cancer at age ≥65 in 1992 through 1996 with last follow-up of December 31, 1999 in five states and six metropolitan areas. Hazard ratio (HR) for all-cause mortality was used for survival analysis with adjustment for patient and tumor characteristics; propensity analysis was used to control for observed factors; and sensitivity analysis was used to estimate potential effects of unmeasured confounders. Results. After adjusting for propensity to receive chemotherapy, the chemotherapy-treated and untreated groups were not statistically significantly different for covariates except for age and hormone receptor status. Mortality was significantly reduced in women aged 65-69 who received adjuvant chemotherapy compared to those who did not, after adjusting for patient and tumor characteristics (HR = 0.70, 95{\%} confidence interval [CI], 0.57-0.88) or after adjusting for propensity scores (HR = 0.76, 95{\%} CI, 0.62-0.94). HR did not significantly differ between the treated and untreated women aged ≥70 (HR = 0.96, 95{\%} CI = 0.83-1.09, and HR = 0.99, 95{\%} CI, 0.87-1.14). These results were relatively insensitive to changes in unmeasured confounders. Conclusions. Adjuvant chemotherapy is associated with improved survival in women with node-positive operable breast cancer aged 65-69 living in the community, but not in women aged ≥70. These findings are consistent with those found in randomized controlled trials.",
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N2 - Background. Randomized clinical trials have shown the efficacy of adjuvant chemotherapy in treating node-positive operable breast cancer in women aged ≤69 years, but the benefit of chemotherapy in women aged ≥70 is questionable. This study was to examine if adjuvant chemotherapy is effective for these women with breast cancer. Methods. We studied a cohort of 5464 women diagnosed with node-positive operable breast cancer at age ≥65 in 1992 through 1996 with last follow-up of December 31, 1999 in five states and six metropolitan areas. Hazard ratio (HR) for all-cause mortality was used for survival analysis with adjustment for patient and tumor characteristics; propensity analysis was used to control for observed factors; and sensitivity analysis was used to estimate potential effects of unmeasured confounders. Results. After adjusting for propensity to receive chemotherapy, the chemotherapy-treated and untreated groups were not statistically significantly different for covariates except for age and hormone receptor status. Mortality was significantly reduced in women aged 65-69 who received adjuvant chemotherapy compared to those who did not, after adjusting for patient and tumor characteristics (HR = 0.70, 95% confidence interval [CI], 0.57-0.88) or after adjusting for propensity scores (HR = 0.76, 95% CI, 0.62-0.94). HR did not significantly differ between the treated and untreated women aged ≥70 (HR = 0.96, 95% CI = 0.83-1.09, and HR = 0.99, 95% CI, 0.87-1.14). These results were relatively insensitive to changes in unmeasured confounders. Conclusions. Adjuvant chemotherapy is associated with improved survival in women with node-positive operable breast cancer aged 65-69 living in the community, but not in women aged ≥70. These findings are consistent with those found in randomized controlled trials.

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