Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial

Joseph A. Sparano, Molin Wang, Fengmin Zhao, Vered Stearns, Silvana Martino, Jennifer A. Ligibel, Edith A. Perez, Tom Saphner, Antonio C. Wolff, George W. Sledge, William C. Wood, Nancy E. Davidson

Research output: Contribution to journalArticle

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Abstract

Background The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy. Methods The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline-and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided. Results Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P <.001) and a higher body mass index (median: 31.7 vs 27.4 kg/m 2; P <.001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086). Conclusion Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.

Original languageEnglish (US)
Pages (from-to)406-414
Number of pages9
JournalJournal of the National Cancer Institute
Volume104
Issue number5
DOIs
StatePublished - Mar 7 2012

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Hormones
Breast Neoplasms
Drug Therapy
Disease-Free Survival
Survival
Confidence Intervals
Recurrence
Anthracyclines
Proportional Hazards Models
Comorbidity
Body Mass Index
Clinical Trials
Incidence
Population
Neoplasms
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sparano, J. A., Wang, M., Zhao, F., Stearns, V., Martino, S., Ligibel, J. A., ... Davidson, N. E. (2012). Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. Journal of the National Cancer Institute, 104(5), 406-414. https://doi.org/10.1093/jnci/djr543

Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. / Sparano, Joseph A.; Wang, Molin; Zhao, Fengmin; Stearns, Vered; Martino, Silvana; Ligibel, Jennifer A.; Perez, Edith A.; Saphner, Tom; Wolff, Antonio C.; Sledge, George W.; Wood, William C.; Davidson, Nancy E.

In: Journal of the National Cancer Institute, Vol. 104, No. 5, 07.03.2012, p. 406-414.

Research output: Contribution to journalArticle

Sparano, JA, Wang, M, Zhao, F, Stearns, V, Martino, S, Ligibel, JA, Perez, EA, Saphner, T, Wolff, AC, Sledge, GW, Wood, WC & Davidson, NE 2012, 'Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial', Journal of the National Cancer Institute, vol. 104, no. 5, pp. 406-414. https://doi.org/10.1093/jnci/djr543
Sparano, Joseph A. ; Wang, Molin ; Zhao, Fengmin ; Stearns, Vered ; Martino, Silvana ; Ligibel, Jennifer A. ; Perez, Edith A. ; Saphner, Tom ; Wolff, Antonio C. ; Sledge, George W. ; Wood, William C. ; Davidson, Nancy E. / Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. In: Journal of the National Cancer Institute. 2012 ; Vol. 104, No. 5. pp. 406-414.
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abstract = "Background The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy. Methods The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline-and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided. Results Of 4817 eligible patients, 405 (8.4{\%}) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9{\%} vs 17.2{\%}; P <.001) and a higher body mass index (median: 31.7 vs 27.4 kg/m 2; P <.001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7{\%} vs 84.5{\%}; hazard ratio of recurrence or death = 1.58, 95{\%} confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6{\%} vs 91.9{\%}; hazard ratio of death = 1.49, 95{\%} confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086). Conclusion Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.",
author = "Sparano, {Joseph A.} and Molin Wang and Fengmin Zhao and Vered Stearns and Silvana Martino and Ligibel, {Jennifer A.} and Perez, {Edith A.} and Tom Saphner and Wolff, {Antonio C.} and Sledge, {George W.} and Wood, {William C.} and Davidson, {Nancy E.}",
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AU - Sparano, Joseph A.

AU - Wang, Molin

AU - Zhao, Fengmin

AU - Stearns, Vered

AU - Martino, Silvana

AU - Ligibel, Jennifer A.

AU - Perez, Edith A.

AU - Saphner, Tom

AU - Wolff, Antonio C.

AU - Sledge, George W.

AU - Wood, William C.

AU - Davidson, Nancy E.

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N2 - Background The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy. Methods The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline-and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided. Results Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P <.001) and a higher body mass index (median: 31.7 vs 27.4 kg/m 2; P <.001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086). Conclusion Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.

AB - Background The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy. Methods The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline-and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided. Results Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P <.001) and a higher body mass index (median: 31.7 vs 27.4 kg/m 2; P <.001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086). Conclusion Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.

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