Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and ...resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13).
The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate.
Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P = 0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival.
With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.
Real-life analysis of overall survival (OS) trends among metastatic breast cancer (MBC) patients may help define medical needs and evaluate the impact of public health investments. The present study ...aimed to evaluate the independent impact of the year of MBC diagnosis on OS in the Epidemio-Strategy-Medical-Economical (ESME)-MBC cohort.
ESME-MBC (NCT03275311) is a French, national, multicentre, observational cohort including 16,702 consecutive newly diagnosed MBC patients (01 January 2008–31 December 2014). Of 16,680 eligible patients, 15,085 had full immunohistochemistry data, allowing classification as hormone receptor–positive and HER2-negative (HR+/HER2–, N = 9907), HER2-positive (HER2+, N = 2861) or triple-negative (HR–/HER2–, N = 2317) subcohorts. Multivariate analyses of OS were conducted among the full ESME cohort and subcohorts.
Median OS of the whole cohort was 37.22 months (95% confidence interval CI, 36.3–38.04). Year of diagnosis was an independent predictor of OS (hazard ratio 0.98 95% CI, 0.97–1.00, P = .01) together with age, subtype, disease-free interval, visceral metastases and number of organs involved. Median OS of HR+/HER2–, HER2+ and HR–/HER2– subcohorts was, respectively, 42.12 (95% CI, 40.90–43.10), 44.91 (95% CI, 42.51–47.90) and 14.52 (95% CI, 13.70–15.24) months. Year of diagnosis was a strong independent predictor of OS in HER2+ subcohort (hazard ratio 0.91 95% CI, 0.88–0.94, P < .001), but not in HR+/HER2– nor HR–/HER2– subcohorts (hazard ratio 1.00 95% CI, 0.98–1.01, P = .80 and 1.00 95% CI, 0.97–1.02, P = .90, respectively).
The OS of MBC patients has slightly improved over the past decade. However, this effect is confined to HER2+ cases, highlighting the need of new strategies in the other subtypes.
•Overall survival (OS) of metastatic breast cancer patients has slightly improved over the past decade.•OS improvement was confined to Epidermal Growth Factor (HER)-2-overexpressing metastatic breast cancer patients.•The uptake of therapeutic innovations was lower than expected.
Overall survival (OS) is the gold standard endpoint to assess treatment efficacy in cancer clinical trials. In metastatic breast cancer (mBC), progression-free survival (PFS) is commonly used as an ...intermediate endpoint. Evidence remains scarce regarding the degree of association between PFS and OS. Our study aimed to describe the individual-level association between real-world PFS (rwPFS) and OS according to first-line treatment in female patients with mBC managed in real-world setting for each BC subtype (defined by status for both hormone-receptor HR expression and HER2 protein expression/gene amplification).
We extracted data from the ESME mBC database (NCT03275311) which gathers deidentified data from consecutive patients managed in 18 French Comprehensive Cancer Centers. Adult women diagnosed with mBC between 2008 and 2017 were included. Endpoints (PFS, OS) were described using the Kaplan-Meier method. Individual-level associations between rwPFS and OS were estimated using the Spearman's correlation coefficient. Analyses were conducted by tumor subtype.
20,033 women were eligible. Median age was 60.0 years. Median follow-up duration was 62.3 months. Median rwPFS ranged from 6.0 months (95% CI 5.8-6.2) for HR-/HER2 - subtype to 13.3 months (36% CI 12.7-14.3) for HR + /HER2 + subtype. Correlation coefficients were highly variable across subtypes and first-line (L1) treatments. Among patients with HR - /HER2 - mBC, correlation coefficients ranged from 0.73 to 0.81, suggesting a strong rwPFS/OS association. For HR + /HER2 + mBC patients, the individual-level associations were weak to strong with coefficients ranging from 0.33 to 0.43 for monotherapy and from 0.67 to 0.78 for combined therapies.
Our study provides comprehensive information on individual-level association between rwPFS and OS for L1 treatments in mBC women managed in real-life practice. Our results could be used as a basis for future research dedicated to surrogate endpoint candidates.
The carcinogenic effect of radiofrequency electromagnetic fields in humans remains controversial. However, it has been suggested that they could be involved in the aetiology of some types of brain ...tumours. Objectives The objective was to analyse the association between mobile phone exposure and primary central nervous system tumours (gliomas and meningiomas) in adults. Methods CERENAT is a multicenter case-control study carried out in four areas in France in 2004–2006. Data about mobile phone use were collected through a detailed questionnaire delivered in a face-to-face manner. Conditional logistic regression for matched sets was used to estimate adjusted ORs and 95% CIs. Results A total of 253 gliomas, 194 meningiomas and 892 matched controls selected from the local electoral rolls were analysed. No association with brain tumours was observed when comparing regular mobile phone users with non-users (OR=1.24; 95% CI 0.86 to 1.77 for gliomas, OR=0.90; 95% CI 0.61 to 1.34 for meningiomas). However, the positive association was statistically significant in the heaviest users when considering life-long cumulative duration (≥896 h, OR=2.89; 95% CI 1.41 to 5.93 for gliomas; OR=2.57; 95% CI 1.02 to 6.44 for meningiomas) and number of calls for gliomas (≥18 360 calls, OR=2.10, 95% CI 1.03 to 4.31). Risks were higher for gliomas, temporal tumours, occupational and urban mobile phone use. Conclusions These additional data support previous findings concerning a possible association between heavy mobile phone use and brain tumours.
The exhaustive collection of new sarcoma cases and their second histologic review offer a unique opportunity to study their incidence and time trends in France according to the major subtypes.
Data ...were collected from population-based cancer registries covering 22% of the French population. Crude and world age-standardized incidence rates (ASR) were estimated according to anatomic, histological and genetic groups, age and sex over the 2010-2013 period.
Time trends in incidence were calculated by the annual percent change over the 2000-2013 period. During the most recent period (2010-2013), 3942 patients with sarcoma were included. The ASR of soft-tissue and bone sarcomas, and gastro-intestinal stromal tumors (GIST) were 2.1, 1.0 and 0.6, respectively. For the four most frequent histological subtypes (unclassified, leiomyosarcoma, GIST and liposarcoma), the ASR ranged from 0.4 to 0.7. ASRs were 1.9 for complex genomic and 1.3 for recurrent translocation sarcomas. The time-trend analysis showed a significant increase of sarcoma incidence rate between 2000 and 2005, which stabilized thereafter. Incidence rates increased for four histological subtypes (GIST, chondrosarcoma, myxofibrosarcoma, solitary fibrous tumors) and decreased for three (leiomyosarcomas, Kaposi sarcoma and fibrosarcoma).
To our knowledge, this study is the first to investigate sarcoma incidence based on a systematic pathological review of these cancers and on the updated sarcoma classifications. Due to the paucity of literature on sarcomas, future studies using data from population-based cancer registries should consider a standardized inclusion criterion presented in our study to better describe and compare data between countries.
Treatment of metastatic non-small cell lung cancer (mNSCLC) has been modified due to the development of immunotherapy. We assessed survival outcomes (overall OS and progression-free rwPFS survivals, ...time-to-next-treatment TNT) in mNSCLC patients after first-line immunotherapy and chemotherapy in real-life settings. Association between rwPFS and TNT, two candidate surrogate endpoints (SE), with OS was assessed. This retrospective multi-center study uses data from patients included in the Epidemio-Strategy Medico-Economic program with mNSCLC over 2015-2019. The impact of treatment on rwPFS/OS was evaluated with Cox models. Individual-level associations between SE and OS were estimated with an iterative multiple imputation approach and joint survival models. The population included 5294 patients (63 years median age). Median OS in immunotherapy group was 16.4 months (95%CI 14.1-NR) and was higher than in chemotherapy group (11.6 months; 95%CI 11.0-12.2). Improved OS was observed for the immunotherapy group after 3 months for subjects with performance status 0-1 (HR = 0.59; 95%CI 0.42-0.83, p < 0.01). The associations between rwPFS and TNT with OS were close (Formula: see text=0.57). Results emphasized a survival improvement with immunotherapy for patients in good health condition. There was moderate evidence of individual-level association between candidate SE and OS.
Background.
A multidimensional geriatric assessment (GA) is recommended in older cancer patients to inventory health problems and tailor treatment decisions accordingly but requires considerable time ...and human resources. The G8 is among the most sensitive screening tools for selecting patients warranting a full GA but has limited specificity. We sought to develop and validate an optimized version of the G8.
Patients and Methods.
We used a prospective cohort of cancer patients aged ≥70 years referred to geriatricians for GA (2007–2012: n = 729 training set; 2012–2014: n = 414 validation set). Abnormal GA was defined as at least one impaired domain across seven validated tests. Multiple correspondence analysis, multivariate logistic regression, and bootstrapped internal validation were performed sequentially.
Results.
The final model included six independent predictors for abnormal GA: weight loss, cognition/mood, performance status, self‐rated health status, polypharmacy (≥6 medications per day), and history of heart failure/coronary heart disease. For the original G8, sensitivity was 87.2% (95% confidence interval, 84.3–89.7), specificity 57.7% (47.3–67.7), and area under the receiver‐operating characteristic curve (AUROC) 86.5% (83.5–89.6). The modified G8 had corresponding values of 89.2% (86.5–91.5), 79.0% (69.4–86.6), and 91.6% (89.3; 93.9), with higher AUROC values for all tumor sites and stable properties on the validation set.
Conclusion.
A modified G8 screening tool exhibited better diagnostic performance with greater uniformity across cancer sites and required only six items. If these features are confirmed in other settings, the modified tool may facilitate selection for a full GA in older patients with cancer.
Implications for Practice:
Several screening tools have been developed to identify older patients with cancer likely to benefit from a complete geriatric assessment, but none combines appropriate sensitivity and specificity. Based on a large prospective cohort study, an optimized G8 tool was developed, combining a systematic statistical approach with expert judgment to ensure optimal discriminative power and clinical relevance. The improved screening tool achieves high sensitivity, high specificity, better homogeneity across cancer types, and greater parsimony with only six items needed, facilitating selection for a full geriatric assessment.
In an effort to develop an optimized G8 tool combining a systematic statistical approach with expert judgment to ensure optimal discriminative power and clinical relevance, a large prospective cohort study was conducted. The improved screening tool achieves high sensitivity, high specificity, better homogeneity across cancer types, and greater parsimony with only six items needed, facilitating selection for a full geriatric assessment.
Learning Objectives
Identify the features typical of triple‐negative breast cancers on mammography, ultrasound, and magnetic resonance imaging.
Identify this aggressive subtype to accelerate ...diagnosis and treatment and improve outcomes.
Compare typical imaging features of triple‐negative breast cancers with typical imaging features of HR+/HER‐ breast cancers.
Purpose.
Triple‐negative (TN) breast cancers have high malignancy potential and are often characterized by early systemic relapse. Early detection is vital, but there are few comprehensive imaging reports. Here we describe mammography, ultrasound, and magnetic resonance imaging (MRI) findings of TN breast cancers, investigate the specific features of this subtype, and compare the characteristics of TN breast cancers with those of hormone receptor (HR)‐positive/human epidermal growth factor receptor (HER)‐2‐negative breast cancers.
Materials and Methods.
From July 2009 to June 2011, mammography and ultrasound findings of 210 patients with pathologically confirmed TN (n = 105) and HR‐positive/HER‐2‐negative breast cancers (n = 105) were retrospectively reviewed from our institutional database. Ultrasound vascularity was notified in 88 cases and elasticity scores were notified in 49 cases overall. Thirty‐five patients underwent MRI (22 TN and 13 HR‐positive/HER‐2‐negative). Mammograms, ultrasound, and MRI were reviewed according to the Breast Imaging‐Reporting and Data System (BI‐RADS) lexicon and classification.
Results.
TN breast cancers were more likely to show round, oval, or lobulated masses with indistinct margins on mammography than HR‐positive/HER‐2‐negative breast cancers. On ultrasound, TN tumors were more likely than HR‐positive/HER‐2‐negative breast cancers to show circumscribed or microlobulated margins and no posterior acoustic features or posterior enhancement‐positive. On MRI, TN cancers exhibited suspicious aspects more often than HR‐positive/HER‐2‐negative cancers, often with rim enhancement‐positiveHER‐2 (84.6% of masses were classified BI‐RADS 5).
Conclusion.
This study is the first to describe findings on mammography, ultrasound, and MRI for TN breast cancers with a matched HR‐positive/HER‐2‐negative control group. Several distinctive morphological features of these aggressive tumors are identified that can be used for earlier diagnosis and treatment, and ultimately to improve outcomes.
摘要
目的. 三阴性（ TN ）乳腺癌恶性度高，通常以早期全身复发为特征。早期检出三阴乳腺癌至关重要，但迄今还很少开展广泛的影像学研究。在本文中，我们描述了三阴性乳腺癌的乳腺摄影、超声和磁共振成像（ MRI ），探讨了这一乳腺癌亚型的特点，同时比较了三阴性乳腺癌和激素受体（HR）阳性/人表皮生长因子受体（ HER）‐2阴性乳腺癌的特征。
材料和方法： 2009年7月 ～2011年6月，对本机构数据库中的210例经病理学检查证实的三阴性乳腺癌患者（n = 105）和 HR 阳性/HER‐2阴性乳腺癌患者（n =105）的乳腺摄影和超声结果进行回顾性分析。总体来看，88例患者有超声血管分布结果，49例患者有弹性评分结果。35例患者接受了 MRI检查（22例三阴性乳腺癌患者，13例 HR 阳性/HER‐2阴性乳腺癌患者）。根据乳腺癌影像学报告和数据系统（ BI‐RADS ）术语和分类来评价乳腺摄影、超声和 MRI 结果。
结果： 三阴性乳腺癌较HR阳性/HER‐2阴性乳腺癌更有可能在乳腺摄影中出现圆形、卵圆形或边缘不清晰的分叶状肿块。超声检查中，三阴性乳腺癌较 HR 阳性/HER‐2阴性乳腺癌更有可能出现局限性边缘或小分叶边缘，同时无后方回声或后方增强阳性。 MRI 检查中，三阴性乳腺癌较 HR 阳性/HER‐2阴性乳腺癌更有可能出现可疑征象，常伴有边缘增强阳性（84.6%的肿块被分类为BI‐RADS 5 ）。
结论： 本研究首次以相匹配的 HR阳性/HER‐2阴性乳腺癌作为对照，描述了三阴性乳腺癌的乳腺摄影、超声和 MRI 结果。本研究发现了这一浸润性强的肿瘤几个特殊的形态学特征，可用于更早期的诊断和治疗，最终改善患者转归。
Early detection of triple‐negative (TN) breast cancer is vital, but there are few comprehensive imaging reports. Here we describe mammography, ultrasound, and magnetic resonance imaging findings of TN breast cancers, investigate the specific features of this subtype, and compare the characteristics of TN breast cancers with those of hormone receptor‐positive/human epidermal growth factor receptor‐negative breast cancers.
PDF
