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Patterns of Failure in Triple Negative Breast Cancer Patients in an Urban, Predominately Black Population

Journal of Racial and Ethnic Health Disparities volume 8, pages 1035–1046 (2021)Cite this article

Abstract

Triple negative breast cancers (TNBC) behave more aggressively than hormone-receptor positive breast cancers. They are also known preferentially to affect young black women, often leading to poorer outcomes compared with those for white women. We sought to evaluate the comprehensive patterns of failure associated with treatment for TNBC at an urban institution with a predominantly black population and to assess the impact of social determinants of health on treatment failure. A retrospective review of TNBC patients treated from 2005 to 2015 was conducted. Detailed patient, tumor, and treatment characteristics and information on patterns of failure were included. With a median follow-up of 46 months, 32 (16%) documented failures occurred. Locoregional failures comprised 84% of failure patterns whether isolated or in combination with distant failure. Treatment failure was associated with insurance type and smoking status, as well as several tumor characteristics. On multivariate analysis, pathologic nodal staging was the most significant predictor of treatment failure. In contrast to previous studies, we found that black women had higher overall survival than white women, but race was not associated with differences in recurrence patterns or with likelihood of treatment failure. Regardless of race, of the patients who recurred, 53% failed in distant and locoregional sites simultaneously, with an additional 34% failing locally only. These results highlight the need for aggressive local therapies in high-risk patients and suggest a need for improved follow-up focusing on detecting locoregional failures. Multidisciplinary care is essential in the management of these patients at time of failure.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

3D-CRT:

Three-dimensional conformal radiotherapy

AJCC:

American Joint Committee on Cancer

CI:

Confidence interval

ER:

Estrogen receptor

FFR:

Freedom from recurrence

Her-2:

Human epidermal growth factor receptor 2

IDC:

Invasive ductal carcinoma

IHC:

Immunohistochemistry

ILC:

Invasive lobular carcinoma

IMRT:

Intensity-modulated radiotherapy

IRB:

Institutional review board

LVSI:

Lymphovascular space invasion

MVA:

Multivariate analysis

OR:

Odds ratio

OS:

Overall survival

pCR:

Pathologic complete response

PR:

Progesterone receptor

TNBC:

Triple negative breast cancer

UVA:

Univariate analysis

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Author notes

  1. Hua-Ren Cherng and Stephanie R. Rice contributed equally to this work.

Affiliations

  1. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA

    Hua-Ren Cherng, Muhammad Hamza, Sally Cheston, Neha Amin & Elizabeth Nichols

  2. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA

    Stephanie R. Rice

  3. Department of Radiation Oncology, SUNY Upstate Cancer Center, 50 E Adams St, Syracuse, NY, 13210, USA

    Stephanie R. Rice

  4. Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Shruti Murali, Paula Rosenblatt & Katherine H. R. Tkaczuk

  5. Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, MD, USA

    Emily Bellavance

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  1. Hua-Ren Cherng
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Contributions

HRC and SRR compiled and maintained the database and contributed equally to the writing of this manuscript. EMN provided valuable feedback prior to submission. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephanie R. Rice.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee affiliated with the institutional review board of the University of Maryland Baltimore.

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Cherng, HR., Rice, S.R., Hamza, M. et al. Patterns of Failure in Triple Negative Breast Cancer Patients in an Urban, Predominately Black Population. J. Racial and Ethnic Health Disparities 8, 1035–1046 (2021). https://doi.org/10.1007/s40615-020-00860-1

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  • DOI: https://doi.org/10.1007/s40615-020-00860-1

Keywords

  • Triple negative
  • Breast cancer
  • Failure
  • Patterns
  • Predictors
  • Social determinants