Association of black race and outcomes in patients with nonmetastatic triple-negative breast cancer (TNBC): Results from a U.S. local oncology practice.

Document Type

Article

Department

Haematology and Oncology, East Africa

Abstract

Background: TNBC carries a poor prognosis. African American (AA) race has been shown as an adverse prognostic factor in many cancers. The objective of this study was to evaluate, in a real-world context, the impact of AA on disease recurrence and survival among nonmetastatic TNBC patients treated with adjuvant chemotherapy (CT).

Methods: The Georgia Cancer Specialist Database (2003- 2008) was used. Patients with stage (I-III) BC, confirmed TN status, treated with adjuvant CT were followed from initial BC diagnosis to the earliest of death, BC recurrence, or loss to follow-up. The primary outcome was disease-free survival (DFS). The secondary outcome was recurrence. DFS and recurrence were compared between AA and non-AA groups with Kaplan-Meier curves. The impact of AA status was further examined using multivariate Cox models adjusting for age, comorbidity, BMI, smoking status, initial BC stage, surgery, and radiation therapy.

Results: Among 209 TNBC patients, 89 (42.6%) were AA. The two groups (AA vs. non-AA) were similar in mean age at BC diagnosis (53.2 vs. 54.4, p = 0.487), surgery and radiation rates (98.9% vs. 100%, p = 0.244; 68.5% vs. 62.5%, p = 0.365, respectively). Compared to non-AA, AA patients were more obese (BMI: 30.4 vs. 28.6, p=0.048), and more likely to be diagnosed at stage II (stage I: 31.5% vs. 51.7%; stage II: 64.0% vs. 43.3%; stage III: 4.5% vs. 5.0%; p = 0.0107). Compared to non-AA, AA patients had lower 5-year DFS rate (45.2% vs. 79.7%, p = 0.0005), and higher 5-year recurrence rate (42.5% vs. 7.0%, p = 0.0005). The median DFS was significantly shorter for AA than non-AA patients (615 vs. 775 days, p = 0.0005). The multivariate Cox models showed that AA was associated with lower likelihood for DFS (HR = 0.15, p = 0.0005), and higher risk for recurrence (HR = 8.16, p = 0.0006), compared to non-AA patients.

Conclusions: This study suggested that AA race was associated with worse outcomes irrespective of later stage at presentation among TNBC patients who were treated with currently available adjuvant CT. Future studies need to explore genotypic as well as behavioral reasons for inferior outcomes associated with AA race.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Journal of Clinical Oncology

DOI

https://doi.org/10.1200/jco.2010.28.15_suppl.6107

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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