High Comorbidity Increases Risk of Death, Recurrence in Patients With Breast Cancer
By Brian Hoyle
SAN ANTONIO, Tex -- December 13, 2016 -- Patients with breast cancer and comorbidities have a greater risk of cancer recurrence and death, according to a study presented on December 8 at the 39th Annual San Antonio Breast Cancer Symposium (SABCS).
Jiyoung Rhu, MD, Seoul National University College of Medicine, Seoul, Korea, and colleagues retrospectively reviewed the medical records of 2,501 patients treated for primary breast cancer at the same institution from mid-2006 to mid-2010.
Patients were grouped according to pre-operative American Society of Anesthesiologists (ASA) status, with 1,792 (71.6%) being ASA 1, 665 (26.6%) being ASA 2, and 44 (1.8%) being ASA 3. The groups were compared during the median 71- month follow-up for clinic-pathologic characteristics including disease-free survival (DFS), overall survival (OS), and breast cancer-specific survival (BCSS).
The patients were overwhelmingly female (99.8%) although 6 male patients were included. Mean age of the patients was 49.75 ± 10.14 years. Of the patients, 1,637 (65.5%) were oestrogen receptor-positive, 1,321 (52.8%) were progesterone-positive, and 520 (20.8%) were human epidermal growth factor receptor 2 (HER2)-positive.
The majority (66.7%) of patients received breast conserving surgery. Adjuvant hormone therapy was received by 1,632 patients (trastuzumab in 1,082, aromatase inhibitors in 517, and not recorded in 33).
ASA 1 patients displayed better OS than ASA 2 patients (hazard ratio [HR] = 2.084; 95% confidence interval [CI], 1.369-3.173; P = .001) and ASA 3 patients (HR = 5.169; 95% CI, 2.217-12.049; P < .001).
A similar pattern favouring ASA 1 patients was evident for RFS compared with ASA 2 patients, albeit non-significantly (HR = 1.281; 95% CI, 0.984-1.669; P = .066) and significantly compared with ASA 3 (HR = 2.315; 95% CI, 1.185-4.524; P = .014).
Concerning cancer-specific survival, there was no difference between ASA 1 and 2 patients (HR = 1.241; 95% CI, 0.751-2.051; P = .399), but there was a significant difference between ASA 1 and 3 patients (HR = 6.399; 95% CI, 2.222-18.429; P = .001).
Multivariate analysis demonstrated that high ASA 3 was an independent prognostic factor in DFS (HR = 3.356; 95% CI, 1.661-6.780; P = .001), OS (HR = 4.454; 95% CI, 1.753-11.321), and BCSS (HR = 6.399; 95% CI, 2.222-18.429; P = .001).
Fewer patients in the high co-morbidity group received adjuvant therapies: ASA 1 (4.3%), ASA 2 (6.6%), and ASA 3 (18.2%).
The increased recurrence of breast cancer in the high morbidity group was mainly in patients who did not receive adjuvant therapies. Serious adverse events during adjuvant therapy were not appreciably influenced by the co-morbidities.
The latest findings comprehensively support earlier observations of the detrimental influence of comorbidity on cancer-related outcome because of decisions made about adjuvant treatments.
[Presentation title: The Association Between Patient Comorbidity and Breast Cancer Survival. Abstract P2-07-12]