Abstract 859: Race-based survival and prognosis among lower SES women with ER/PR negative breast cancer
Authors: Dookeran Keith A. , Ferrer Karen , Sekosan Marin , McCaskill-Stevens Worta 
Published: February 2011

Background: Heterogeneity exists in survival and prognosis among women of different race with ER/PR negative (-) breast cancer. Minority women often have lower SES, which may be a confounding factor. We evaluated survival and prognosis in a cohort of lower SES non-Hispanic White (NHW), African-American (AA), and Hispanic (HIS) women, in an attempt to disaggregate the effects of race and SES in ER/PR- breast cancer.

Methods: Chi-square test was used to examine relationship significance [odds ratios (OR), 95% confidence intervals (CIs)]; survival function estimates were generated using Kaplan-Meier (KM) method and compared using log-rank test; proportional hazards regression models [hazard ratios (HR), 95% CIs] were used to select and evaluate factors prognostic for all-cause mortality, in 213 consecutive [30 NHW, 135 AA & 48 HIS] women treated at an urban hospital [44 months median follow-up] with ER/PR- disease.

Results: HIS women were younger than NHW [OR, 0.36; 95% CI, 0.14-0.94; p =0.0368] and AA [OR, 0.50; 95% CI, 0.26-0.96; p =0386]. Compared to NHW and HIS, AA women had more comorbid disease [ORs: 3.53; 95% CI, 1.43-8.66; p =0.0053; & 2.12; 95% CI, 1.04-4.33; p =0.0392], and worse poverty status level (PL) [ORs: 5.43; 95% CI, 2.17-13.69; p =0.0001; & 2.79; 95% CI 1.17-6.65; p =0.0192]. No significant differences were noted between groups for stage at diagnosis, grade, p53 or HER2 status, and chemotherapy use. Baseline prognostic factors were: age [HR, 0.99/yr; 95% CI, 0.98-1.02; p =0.822]; stage [(II-IV/I) HR, 2.45; 95% CI, 1.85-3.24; p &lt;0.001]; grade [(high/low) HR, 1.19; 95% CI, 0.65-2.15; p =0.575]; p53 [(+/-) HR, 1.01; 95% CI, 0.62-1.63; p =0.982]; HER2 [(+/-) HR, 0.84; 95% CI, 0.50-1.42; p =0.521]; BMI [HR, 0.99/unit; 95% CI, 0.95-1.03; p =0.714]; comorbidity [(+/-) HR, 1.23; 95% CI, 0.76-1.98; p =0.411]; PL [(&gt;/≤ census mean) HR, 2.43; 95% CI, 1.12-5.28; p =0.025]; and chemotherapy [(+/-) HR, 0.51; 95% CI, 0.29-0.89; p =0.017]. Race was not associated with greater hazard mortality [(Other/AA) HR, 0.83; 95% CI, 0.60-1.14; p =0.255], and unadjusted 5-yr survival for NHW, AA and HIS women was 60.9%, 52.4%, and 64.4%. 5-yr survival by race was also not different for women aged &lt;50 yrs (p =0.3287) or ≥50 yrs (p =0.6217). Multivariable models indicated that only stage [HR, 2.45; 95% CI, 1.61-3.74; p &lt;0.001] and chemotherapy [HR, 0.31; 95% CI, 0.10-0.95; p =0.041] remained significant prognostic factors when considered together with the other above-mentioned factors. Further, models for Triple Negative [i.e. ER-, PR-, & HER2- (TN)] phenotype (without HER2 covariate) showed similar results: stage [HR, 2.32; 95% CI, 1.45-3.70; p &lt;0.001]; chemotherapy [HR, 0.23; 95% CI, 0.07-0.75; p =0.015].

Conclusion: Survival is not significantly different among lower SES women with ER/PR- breast cancer of different race. Stage and chemotherapy use, but not race, remained independent prognostic factors in Cox models for ER/PR- and TN disease.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 859.