Kathy S Albain1, Robert J Gray2, Della F Makower3, Amir Faghih4, Daniel F Hayes5, Charles E Geyer6, Elizabeth C Dees7, Matthew P Goetz8, John A Olson9, Tracy Lively10, Sunil S Badve11, Thomas J Saphner12, Lynne I Wagner13, Timothy J Whelan14, Matthew J Ellis15, William C Wood16, Maccon M Keane17, Henry L Gomez18, Pavan S Reddy19, Timothy F Goggins20, Ingrid A Mayer21, Adam M Brufsky22, Deborah L Toppmeyer23, Virginia G Kaklamani24, Jeffrey L Berenberg25, Jeffrey Abrams10, George W Sledge26, Joseph A Sparano3. 1. Loyola University Chicago Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Medical Center, Maywood, IL, USA. 2. Dana Farber Cancer Institute, Boston, MA, USA. 3. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. 4. Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario, Canada. 5. University of Michigan, Ann Arbor, MI, USA. 6. Houston Methodist Cancer Center, Houston, TX, USA. 7. University of North Carolina, Chapel Hill, NC, USA. 8. Mayo Clinic, Rochester, MN, USA. 9. University of Maryland School of Medicine, Baltimore, MD, USA. 10. National Institutes of Health, National Cancer Institute, Bethesda, MD, USA. 11. Indiana University School of Medicine, Indianapolis, IN, USA. 12. Aurora Health Care, Two Rivers, WI, USA. 13. Wake Forest University Health Service, Winston Salem, NC, USA. 14. McMaster University, Hamilton, Canada. 15. Baylor College of Medicine, Houston, TX, USA. 16. Emory University, Atlanta, GA, USA. 17. Cancer Trials Ireland, Dublin, Ireland. 18. Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru. 19. Cancer Center of Kansas, Wichita, KS, USA. 20. Fox Valley Hematology and Oncology, Appleton, WI, USA. 21. Vanderbilt University, Nashville, TN, USA. 22. University of Pittsburgh, Pittsburgh, PA, USA. 23. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. 24. University of Texas, San Antonio, TX, USA. 25. University of Hawaii Cancer Center, Honolulu, HI, USA. 26. Stanford University, Stanford, CA, USA.
Abstract
BACKGROUND: Black race is associated with worse outcomes in early breast cancer. We evaluated clinicopathologic characteristics, the 21-gene recurrence score (RS), treatment delivered, and clinical outcomes by race and ethnicity among women who participated in the Trial Assigning Individualized Options for Treatment. METHODS: The association between clinical outcomes and race (White, Black, Asian, other or unknown) and ethnicity (Hispanic vs non-Hispanic) was examined using proportional hazards models. All P values are 2-sided. RESULTS: Of 9719 eligible women with hormone receptor-positive, HER2-negative, node-negative breast cancer, there were 8189 (84.3%) Whites, 693 (7.1%) Blacks, 405 (4.2%) Asians, and 432 (4.4%) with other or unknown race. Regarding ethnicity, 889 (9.1%) were Hispanic. There were no substantial differences in RS or ESR1, PGR, or HER2 RNA expression by race or ethnicity. After adjustment for other covariates, compared with White race, Black race was associated with higher distant recurrence rates (hazard ratio [HR] = 1.60, 95% confidence intervals [CI] = 1.07 to 2.41) and worse overall survival in the RS 11-25 cohort (HR = 1.51, 95% CI = 1.06 to 2.15) and entire population (HR = 1.41, 95% CI = 1.05 to 1.90). Hispanic ethnicity and Asian race were associated with better outcomes. There was no evidence of chemotherapy benefit for any racial or ethnic group in those with a RS of 11-25. CONCLUSIONS: Black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. Similar to Whites, Black women did not benefit from adjuvant chemotherapy if the 21-gene RS was 11-25. Further research is required to elucidate the basis for this racial disparity in prognosis.
BACKGROUND: Black race is associated with worse outcomes in early breast cancer. We evaluated clinicopathologic characteristics, the 21-gene recurrence score (RS), treatment delivered, and clinical outcomes by race and ethnicity among women who participated in the Trial Assigning Individualized Options for Treatment. METHODS: The association between clinical outcomes and race (White, Black, Asian, other or unknown) and ethnicity (Hispanic vs non-Hispanic) was examined using proportional hazards models. All P values are 2-sided. RESULTS: Of 9719 eligible women with hormone receptor-positive, HER2-negative, node-negative breast cancer, there were 8189 (84.3%) Whites, 693 (7.1%) Blacks, 405 (4.2%) Asians, and 432 (4.4%) with other or unknown race. Regarding ethnicity, 889 (9.1%) were Hispanic. There were no substantial differences in RS or ESR1, PGR, or HER2 RNA expression by race or ethnicity. After adjustment for other covariates, compared with White race, Black race was associated with higher distant recurrence rates (hazard ratio [HR] = 1.60, 95% confidence intervals [CI] = 1.07 to 2.41) and worse overall survival in the RS 11-25 cohort (HR = 1.51, 95% CI = 1.06 to 2.15) and entire population (HR = 1.41, 95% CI = 1.05 to 1.90). Hispanic ethnicity and Asian race were associated with better outcomes. There was no evidence of chemotherapy benefit for any racial or ethnic group in those with a RS of 11-25. CONCLUSIONS: Black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. Similar to Whites, Black women did not benefit from adjuvant chemotherapy if the 21-gene RS was 11-25. Further research is required to elucidate the basis for this racial disparity in prognosis.
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