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Breast Cancer Research and Treatment

, Volume 139, Issue 2, pp 497–506 | Cite as

Black race as a prognostic factor in triple-negative breast cancer patients treated with breast-conserving therapy: a large, single-institution retrospective analysis

  • Carmen A. Perez
  • Zachary S. Zumsteg
  • Gaorav Gupta
  • Monica Morrow
  • Brittany Arnold
  • Sujata M. Patil
  • Tiffany A. Traina
  • Mark E. Robson
  • Yong H. Wen
  • Beryl McCormick
  • Simon N. Powell
  • Alice Y. HoEmail author
Epidemiology

Abstract

Triple-negative breast cancer (TNBC) disproportionately affects black women. However, black race as a prognostic factor in TNBC has not been well studied. We evaluated the effect of race, among other variables, on outcomes in women with TNBC. A total of 704 patients with stages I–III TNBC treated with breast-conserving surgery ± adjuvant radiation therapy (RT) and chemotherapy were identified from an institutional database. Competing risk analyses, Kaplan–Meier methods, and Cox proportional hazards models identified associations among clinicopathologic variables on locoregional recurrence (LRR), distant recurrence (DR), and overall survival (OS). LRR was defined as a biopsy proven, triple receptor-negative recurrence in the ipsilateral breast or regional lymph nodes. At a median follow-up of 51 months, there were 55 LRR, 61 DR, and 111 death events. Compared to non-black women, black women had higher disease stage and were more likely to receive axillary lymph node dissection, chemotherapy, and nodal irradiation (all P < 0.05). After adjustment for stage, age, lymphovascular invasion, chemotherapy, and RT on multivariate analysis, black race was prognostic for increased risk of LRR (hazard ratio [HR] = 3.17; 95 % confidence interval: 1.7–5.8; P = 0.0002). The 5-year risk of regional recurrence was higher in black women (10 vs. 2 %, P < 0.0001), but local failures were similar between groups (3.0 vs. 5.3 %, P = 0.15). RT was an independent predictor for decreased LRR and increased OS on multivariate analyses (P = 0.0006 and P = 0.0003, respectively). Black women with TNBC had equivalent local control, but higher risk of regional nodal failure, compared with non-black counterparts. The routine use of comprehensive nodal irradiation may be beneficial for black women with TNBC.

Keywords

Triple-negative breast cancer Race Recurrence Outcomes 

Abbreviations

ALND

Axillary lymph node dissection

BMI

Body mass index

BCS

Breast-conserving surgery

BRCA1/BRCA2

Breast cancer susceptibility genes

CI

Confidence intervals

DR

Distant recurrence

DOC

Death due to cause other than breast cancer

HR

Hazard ratio

LRR

Locoregional recurrence

LVI

Lymphovascular invasion

MSKCC

Memorial Sloan-Kettering Cancer Center

OS

Overall survival

PR

Progesterone receptor

RT

Radiation therapy

SCV

Supraclavicular

SLND

Sentinel lymph node dissection

TNBC

Triple-negative breast cancer

Notes

Acknowledgments

We thank the staff of the breast disease management team and the clinical genetics service database at MSKCC for their continuous support in maintaining the retrospective database used for this research.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Carmen A. Perez
    • 1
  • Zachary S. Zumsteg
    • 1
  • Gaorav Gupta
    • 1
  • Monica Morrow
    • 2
  • Brittany Arnold
    • 1
  • Sujata M. Patil
    • 3
  • Tiffany A. Traina
    • 4
  • Mark E. Robson
    • 4
  • Yong H. Wen
    • 5
  • Beryl McCormick
    • 1
  • Simon N. Powell
    • 1
  • Alice Y. Ho
    • 1
    Email author
  1. 1.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Biostatistics and EpidemiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  5. 5.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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