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- Title
Racial and Ethnic Disparity in Preoperative Chemosensitivity and Survival in Patients With Early-Stage Breast Cancer.
- Authors
Roy, Arya Mariam; Patel, Archit; Catalfamo, Kayla; Attwood, Kristopher; Khoury, Thaer; Yao, Song; Gandhi, Shipra
- Abstract
Key Points: Question: Is there racial and ethnic disparity in preoperative chemosensitivity in early-stage breast cancer? Findings: In this cohort study of 103 605 patients with early-stage breast cancer who received neoadjuvant chemotherapy, Black patients had more refractory disease in ERBB2-positive and triple-negative breast cancer. Black patients had significantly inferior survival rates compared with other races and ethnicities across all breast cancer subtypes, and this disparity was pronounced among those with sensitive and refractory preoperative chemosensitivity. Meaning: These findings suggest the presence of racial and ethnic disparity in preoperative chemosensitivity among patients with early-stage breast cancer and that there is a need for personalized treatment options for Black patients. Importance: It remains unclear what survival benefit is associated with preoperative chemosensitivity after receiving neoadjuvant chemotherapy (NACT) among patients with resectable breast cancer from diverse racial and ethnic backgrounds. Objective: To investigate racial and ethnic disparities in chemosensitivity and association with survival in patients with early-stage breast cancer. Design, Setting, and Participants: This retrospective cohort study queried data from the National Cancer Database (NCDB) between calendar years 2010 and 2018. Participants included patients with breast cancer with clinical stage I to III disease treated with NACT. Preoperative chemosensitivity was defined as very sensitive (ypT0N0), sensitive (pathologic TNM stage less than clinical stage, excluding ypT0N0), and refractory (pathologic stage greater than or equal to clinical stage). Data were analyzed in November 2022. Exposure: Receipt of NACT and clinicopathologic and treatment factors contributing to racial and ethnic disparities in survival. Main Outcomes and Measures: Overall survival of patients from diverse racial and ethnic backgrounds who received NACT. Results: This study included 103 605 patients (median age, 53 [IQR, 44-62] years, 99.5% [n = 103 060] women, and 68.7% [n = 71 203] White race). Among them, breast cancer was refractory in 43.2% (n = 44 796), sensitive in 34.4% (n = 35 638), and very sensitive in 22.4% (n = 23 171) of patients. In the hormone receptor–positive ERBB2 negative (formerly HER2 negative) group, patients had more refractory disease regardless of race or ethnicity (all races and ethnicities refractory: 54%-59%; P <.001). Among ERBB2 positive disease, Black patients had a lower percentage of very sensitive disease (32% vs 37%-40%; P <.001) and among triple-negative breast cancer, more refractory disease was seen among Black patients compared with other races and ethnicities (38% vs 30%-35%; P <.001). In refractory (hazard ratio [HR], 1.53; 95% CI, 1.47-1.60; P <.001) and sensitive (HR, 1.25; 95% CI, 1.17-1.33; P <.001) disease, Black patients had a higher mortality risk compared with White patients in the overall cohort. Asian patients had a lower mortality risk compared with White patients in refractory (HR, 0.71; 95% CI, 0.63-0.80; P <.001), sensitive (HR, 0.58; 95% CI, 0.49-0.69; P <.001), and very sensitive (HR, 0.60; 95% CI, 0.43-0.82; P <.001) disease groups in the overall cohort. Conclusions and Relevance: In this cohort study, Black patients had a higher mortality risk compared with White patients among those with residual disease after NACT. This highlights the need for personalized treatment strategies for Black patients to help them attain pathologic complete response. This cohort study examines the association of chemosensitivity with survival by race and ethnicity in patients with early-stage breast cancer.
- Subjects
BREAST cancer prognosis; PREOPERATIVE care; ADJUVANT chemotherapy; KRUSKAL-Wallis Test; CONFIDENCE intervals; LOG-rank test; RACE; RETROSPECTIVE studies; ACQUISITION of data; FISHER exact test; TUMOR classification; PEARSON correlation (Statistics); MEDICAL records; DESCRIPTIVE statistics; CHI-squared test; KAPLAN-Meier estimator; SURVIVAL analysis (Biometry); DATA analysis software; BREAST tumors; HORMONE receptor positive breast cancer; PROPORTIONAL hazards models; DRUG resistance in cancer cells
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2344517
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.44517