Abstract 184P
Background
Risk of cancer-specific mortality but also competing risks of death have been shown with increasing age. The challenge of adjuvant treatment in the elderly population is to differentiate who will benefit from those who will die from other causes. We aimed to evaluate the prognostic value of screening tools (VES13 and G8) compared to Balducci criteria on non-cancer mortality and deterioration in pts with early-stage BC.
Methods
We performed a prospective study of pts ≥ 70 years (yrs) diagnosed with localized BC (stage I-III) between January 2015 and December 2018. G8, VES13 and Balducci scores were assessed prior to systemic therapy. Deterioration-Free Survival (DFS) was defined as time to loss follow-up due to clinical deterioration (non-tumor related) or death from non-tumor cause. Death due to BC was censored. Cox-regression models and 36-month DFS ROC AUC were used to compare prognostic performance of G8 and VES13 with BalduccI scores.
Results
123 pts were analyzed. Median age was 79,9 yrs (range 70-97.1). 60 pts (48,8%) were ³80 yrs. 44 pts (35,5%) were stage I; 52 pts (42%) stage II, 27 pts (22,5%) stage III at diagnosis. 19 pts (23,5%) received adjuvant chemotherapy. Median FUP was 40.1 m. 36-months DFS was 76%. 50 pts (40.7%) had VES13 ≥ 3 and 67 pts (54.5%) had G8 ≤ 14. 64.4% of pts with VES13 ≥ 3 and 67.2% with G8 ≤ 14 were considered fragile by Balducci criteria. Both VES13 (p=0.001) and G8 (p<0.001) were significantly associated with DFS (Table). ROC AUC (36m-DFS) values for Balducci scores were numerically higher (AUC: 0.777), but no significant difference with VES13 (AUC: 0.716; p=0.215) or G8 (AUC: 0.704; p=0.109) was observed. Table: 184P
| N (%) | Median SLP | HR (p-val) | 36-m DFS | ROC AUC | |
| VES13 | |||||
| ≥ 3 | 73 (59%) | 53.1 m | 4.9 (p=0.001) | 63.6% | 0.716 |
| < 3 | 50 (41%) | NR | 95.2% | ||
| G8 | |||||
| ≤ 14 | 67 (55%) | 53.1 m | 4.9 (p<0.001) | 62.9% | 0.704 |
| > 14 | 56 (45%) | NR | 93.1% | ||
| BALDUCCI | |||||
| Fit | 41 (33%) | NR | 3.1 (p<0.001) | 97.5% | 0.777 |
| Vulnerable | 27 (22%) | NR | 90.5% | ||
| Fragile | 55 (45%) | 44.2 m | 55% |
Conclusions
VES13 and G8 are associated with time to deterioration or non-cancer related death in elderly pts with early-stage BC. Integrating geriatric tools in the decision-making process is necessary to assess life expectancy due to competing mortality risks, especially in the adjuvant setting.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
I. Paredero Perez: Financial Interests, Personal, Invited Speaker: Roche. I. Maestu Maiques: Financial Interests, Personal, Invited Speaker: AstraZeneca. D. Lorente: Financial Interests, Personal, Invited Speaker: Jansen; Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Bayer; Financial Interests, Personal, Invited Speaker: Astellas; Financial Interests, Personal, Invited Speaker: BMS; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Pfizer. All other authors have declared no conflicts of interest.