Abstract PS8-07: Predictors of 10-year overall survival in patients with breast cancer
Authors: Bilani Nadeem , Elson Leah , Liang Hong , Elimimian Elizabeth , Nahleh Zeina 
Published: February 2021

Background: The combination of mass screening programs and improved, targeted therapies have led to a substantial increase in the number of breast cancer (BC) survivors. Despite a growing majority of patients surviving beyond 5 years, few studies have examined prognostic factors associated with 10-year overall survival (OS) in breast cancer.

Methods: We conducted a retrospective analysis of patients with BC using the National Cancer Database (NCDB). Our dataset documents survival leading up to and including the year 2016. Thus, to evaluate factors associated with 10-year OS, we included patients diagnosed between 2004-2006. We described sociodemographic and clinicopathologic characteristics of this cohort using frequencies/percentages. Variables were included in a multiple logistic regression model predicting 10-year OS, and considered statistically significant to a p-value &lt;0.001, due to the large sample size.

Results: A total of n=515,610 patients with BC were analyzed. The age distribution included n=125,657 (24.4%) &lt;50 years, n=256,003 (49.7%) between 50-70 years, and n=133,950 (26.0%) &gt;70 years. N=440,048 (87.6%) were White, n=52,220 (10.4%) were Black, and n=9872 (2.0%) were Asian. 10-year OS by AJCC clinical stage was: 54.5% for patients diagnosed at stage 0, 50.0% at stage I, 42.4% at stage II, 29.7% at stage III, and 6.1% at stage IV. Sociodemographic variables significantly associated with 10-year OS were: age, race, income, insurance status, and facility type (Table 1). Black patients were less likely to exhibit 10-year OS compared to White patients (40.7% compared to 48.0%, OR 0.821, 95% CI 0.786-0.858, p&lt;0.001). Patients with an estimated annual income &gt;$46,000 were more likely to experience 10-year OS compared to those with an annual income &lt;$30,000 (50.5% compared to 41.8%, OR 1.126, 95% CI 1.076-1.178, p&lt;0.001). Compared to patients treated at community cancer programs (CPs), those treated at comprehensive community CPs were more likely to experience long-term survival (47.7% versus 43.8%, OR 1.125, 95% CI 1.077-1.175, p&lt;0.001). Clinicopathologic factors significantly associated with 10-year OS were: Charlson/Deyo comorbidity index, AJCC clinical staging, tumor grade, estrogen receptor (ER) status, progesterone receptor (PR) status, the use of surgery, radiation, chemotherapy, hormonal therapy, and immunotherapy (Table 1). Compared to patients with well-differentiated tumors, those with moderately-differentiated (OR 0.889, 95% CI 0.860-0.919, p&lt;0.001) and poorly-differentiated tumors (OR 0.782, 95% CI 752-0.812, p&lt;0.001) had lower long-term survival. ER positivity was associated with a lower likelihood of 10-year OS, while PR positivity was associated with a higher likelihood of 10-year OS. However, effect sizes for receptor status are small (ORs between 0.90-1.10), and thus may not have clinical relevance despite statistical significance. HER2 status was not documented in the NCDB before 2010, so its prognostic value could not be evaluated. Tumor histology was not significantly associated with 10-year OS.

Conclusions: 10-year OS data for BC is scarce. We found high rates of 10-year OS, particularly in patients diagnosed at early stages. This is welcomed news; emphasizing the real-world impact of population screening. As anticipated, racial disparities and social determinants of health remain relevant prognosticators of long-term survival.

Table 1: Multiple logistic regression model predicting 10-year OS in patients with breast cancer.VariableNo. (%)10-year OS%OR95% CIp-valueAge&lt;.001&lt;50 (ref)125,657 (24.4%)54.1%1.000---50-70256,003 (49.7%)53.0%.946.916.978.001&gt;70133,950 (26.0%)30.1%.427.407.448&lt;.001Race&lt;.001White (ref)440,048 (87.6%)48.0%1.000---Black52,220 (10.4%)40.7%.821.786.858&lt;.001Asian9872 (2.0%)51.9%1.1661.0671.275.001EthnicityHispanic (ref)445,220 (95.6%)47.7%1.000---Non-Hispanic20,481 (4.4%)44.4%.936.878.998.042Income&lt;.001&lt;$30,000 (ref)55,038 (11.0%)41.8%1.000---$30,000-$34,99979,054 (15.8%)44.9%1.026.9771.078.296$35,000-$45,999133,171 (26.6%)46.7%1.0651.0171.115.008&gt;$46,000233,078 (46.6%)50.5%1.1261.0761.178&lt;.001Insurance status&lt;.001Uninsured (ref)10,440 (2.1%)36.8%1.000---Private insurance284,063 (56.5%)55.4%1.5521.4171.701&lt;.001Medicare181,088 (36.0%)36.5%1.2641.1501.390&lt;.001Medicaid/other governmental insurance26,766 (5.3%)41.8%1.2111.0921.343&lt;.001Facility type&lt;.001Community cancer program (ref)46,176 (9.4%)43.8%1.000---Comprehensive community cancer program227,815 (46.5%)47.7%1.1251.0771.175&lt;.001Academic/research program142,123 (29.0%)49.0%1.0631.0151.113.010Integrated network cancer program73,703 (15.0%)44.6%.819.776.865&lt;.001Setting.001Metro (ref)427,832 (85.6%)47.6%1.000---Urban63,288 (12.7%)47.4%1.0761.0341.120&lt;.001Rural8534 (1.7%)47.4%1.091.9841.209.099Charlson/Deyo comorbidity index.0000 (ref)450,329 (87.3%)49.1%1.000---152,983 (10.3%)38.3%.746.717.777&lt;.00129425 (1.8%)25.1%.506.459.557&lt;.00132873 (0.6%)16.4%.343.280.421&lt;.001AJCC clinical staging&lt;.0010 (ref)59,736 (25.7%)54.5%1.000---187,698 (37.7%)50.0%.731.703.760&lt;.001251,604 (22.2%)42.4%.526.503.551&lt;.001318,871 (8.1%)29.7%.281.264.299&lt;.001414,620 (6.3%)6.1%.073.065.082&lt;.001Grade&lt;.001Well-differentiated (ref)94,046 (21.2%)51.6%1.000---Moderately-differentiated184,976 (41.7%)48.5%.889.860.919&lt;.001Poorly differentiated164,490 (37.1%)44.9%.782.752.812&lt;.001Histology.007Ductal carcinoma (ref)367,409 (72.7%)47.7%1.000---Lobular carcinoma79,387 (15.7%)47.3%.993.9571.031.720Other carcinoma47,959 (9.5%)49.1%1.013.9661.061.598Epithelial-myoepithelial1861 (0.4%)42.1%.898.7031.146.385Papillary6005 (1.2%)30.8%1.054.8831.260.559Fibroepithelial2058 (0.4%)34.9%.937.7551.162.552Mesenchymal402 (0.1%)21.4%.7130.3091.645427Estrogen receptor statusNegative (ref)97,628 (21.9%)43.9%1.000---Positive348,611 (78.1%)48.6%.908.868.949&lt;.001Progesterone receptor statusNegative (ref)147,951 (33.6%)44.0%1.000---Positive292,529 (66.4%)49.3%1.0951.0571.134&lt;.001Type of surgery.000None (ref)30,799 (6.0%)15.8%1.000---Lumpectomy294,554 (57.3%)52.6%2.3002.1122.506&lt;.001Mastectomy188,531 (36.7%)44.3%2.3202.1342.523&lt;.001RadiationNo (ref)239,355 (47.5%)40.4%1.000---Yes264,681 (52.5%)53.3%1.3851.3411.430&lt;.001ChemotherapyNo (ref)309,000 (62.9%)46.0%1.000---Yes182,510 (37.1%)49.2%1.3751.3311.420&lt;.001Hormonal therapyNo (ref)245,859 (51.0%)42.3%1.000---Yes236,454 (49.0%)51.9%1.2071.1671.248&lt;.001ImmunotherapyNo (ref)497,793 (99.6%)47.2%1.000---Yes1862 (0.4%)43.3%1.2731.2361.311&lt;.001

Citation Format: Nadeem Bilani, Leah Elson, Hong Liang, Elizabeth Elimimian, Zeina Nahleh. Predictors of 10-year overall survival in patients with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-07.