Table S br Association of diabetes and measured anthropometr
Association of diabetes and measured anthropometric variables with risk of pancreatic cancer in the Women's Health Initiative excluding the first 3 years of follow-up
Exposures HR* 95% CI HRy 95% CI HRz 95% CI Diabetes
Waist circumference (cm)
* Adjusted for age only.
y Adjusted for age (continuous), smoking status (never smoked, former smoker, current smoker), pack-years of smoking (continuous), alcohol intake (servings/day), metabolic equivalent task hrs/week (MET-hrs/weekdcontinuous), educational level (less than high school grad, high school grad/some college, college grad, post-college), race (white, black, other), and allocation to the OS or treatment/placebo/control arm of clinical trials unless included as main exposure.
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Adjuvant Chemotherapy Guidance in Young Breast Cancer Patients With Luminal Subtypes and Stage pT1N0
a Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
b Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
Received in revised form
histological grade 3
Background: This study evaluated whether young breast cancer patients ( 40 y of age) with luminal subtypes and stage pT1N0 can benefit from chemotherapy (CHT).
Materials and methods: This study included 688 patients aged 40 y with luminal subtypes and stage pT1N0 breast cancer. The overall survival and disease-free survival (DFS) rates in the whole cohort and subgroups were compared between patients receiving CHT followed by endocrinotherapy (ET) (CHT/ET group) and those receiving only ET (ET-alone group). Results: Univariate analysis identified that the tumors in the CHT/ET group were more aggressive than those in the ET-alone group. However, the overall survival and DFS rates did not differ significantly between the CHT/ET and ET-alone groups (P ¼ 0.416 and 0.21, respectively), implying that a subgroup of patients could benefit from CHT. Subgroup analysis of DFS rates revealed that patients with human epidermal growth factor receptor 2 overexpression (P ¼ 0.042), histological classification grade 3 (P ¼ 0.030), LLY507 re-ceptor 20% (P ¼ 0.033), and clinical stage T1c (P ¼ 0.038) could benefit from CHT. Further analysis showed that these four risk factors combined predicted whether the patient could benefit from CHT.
Conclusions: Young patients with hormone receptorepositive and stage pT1N0 breast can-cer may benefit from CHT only if they exhibit at least two of the following risk factors: progesterone receptor 20%, human epidermal growth factor receptor 2 overexpression, histological grading 3, or clinical stage T1c.
ª 2019 Elsevier Inc. All rights reserved.
The National Cancer Center reported that the incidence and mortality of breast cancer (BC) in 2015 ranked first and six, respectively, among all cancers affecting women in China.
Nearly 75% of these patients had hormone receptor (HR)-positive BC.1 HR-positive BC patients are sensitive to endo-crinotherapy (ET) and also have a better prognosis compared with those with other types of BC.2 However, HR-positive BC patients have a higher risk of recurrence. Cytotoxic
* Corresponding author. Department of breast surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041,
chemotherapy (CHT) remains one of the most commonly used systemic treatments and is proven to be effective.3-5 Among patients at a lower risk of recurrence, the current recom-mendation is that ET alone is enough as there is no significant difference in overall survival (OS) or disease-free survival (DFS) rates regardless of CHT before ET. In addition, there is a higher incidence of complications with CHT.6 However, the definition of lower risk is not clear. The development of ge-netic tests such as Oncotype DX, EndoPredict, and MammaP-rint in recent years has allowed the identification of subgroups of early BC patients at a lower risk who could achieve a satisfactory prognosis through ET alone. However, genetic testing is not widely performed, and there is no uniform standard of quality in European and American countries, let alone in developing countries such as China.
Immunohistochemistry (IHC) combined with pathological parameters has proven to be relatively accurate and is widely used for the evaluation of prognoses.7 Therefore, the potential use of these findings to predict the benefits of CHT is of great interest, especially for patients in developing countries with HR-positive and stage pT1N0 BC who cannot undergo genetic testing. Furthermore, the mean age at diagnosis of BC in China is considerably lower than that in western countries.4,5 The St. Gallen International Expert Consensus (IEC) meetings before 2009 regarded a younger age at onset as a high-risk factor.8 However, recent guidelines, including the St. Gallen IEC, do not consider a younger age at onset to be a poor prognostic factor.3,6,9 Surprisingly, these guidelines recommend more effective ET (mean ovarian function suppression þ aromatase inhibitor/tamoxifen compared with tamoxifen alone) for younger ( 40 y) HR-positive BC patients3,10 due to their higher risk of relapse.11-13 Therefore, there remains ongoing dispute over whether younger BC patients should be treated with more aggressive therapies, especially CHT.10,12,14,15