Sociodemographic Factors Associated With Rapid Relapse in Triple-Negative Breast Cancer: A Multi-Institution Study

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  • 1 Ohio State University Wexner Medical Center, Columbus, Ohio;
  • | 2 MD Anderson Cancer Center, Houston, Texas;
  • | 3 Fox Chase Cancer Center, Philadelphia, Pennsylvania;
  • | 4 University of Utah, Salt Lake City, Utah;
  • | 5 Seattle Cancer Care Alliance, Seattle, Washington;
  • | 6 Roswell Park Comprehensive Cancer Center, Buffalo, New York;
  • | 7 Dana-Farber Cancer Institute, and
  • | 8 Massachusetts General Hospital, Boston, Massachusetts;
  • | 9 City of Hope National Medical Center, Duarte, California; and
  • | 10 Johns Hopkins University, Baltimore, Maryland.

Background: Triple-negative breast cancer (TNBC) accounts for disproportionately poor outcomes in breast cancer, driven by a subset of rapid-relapse TNBC (rrTNBC) with marked chemoresistance, rapid metastatic spread, and poor survival. Our objective was to evaluate clinicopathologic and sociodemographic features associated with rrTNBC. Methods: We included patients diagnosed with stage I–III TNBC in 1996 through 2012 who received chemotherapy at 1 of 10 academic cancer centers. rrTNBC was defined as a distant metastatic recurrence event or death ≤24 months after diagnosis. Features associated with rrTNBC were included in a multivariable logistic model upon which backward elimination was performed with a P<.10 criterion, with a final multivariable model applied to training (70%) and independent validation (30%) cohorts. Results: Among all patients with breast cancer treated at these centers, 3,016 fit the inclusion criteria. Training cohort (n=2,112) bivariable analyses identified disease stage, insurance type, age, body mass index, race, and income as being associated with rrTNBC (P<.10). In the final multivariable model, rrTNBC was significantly associated with higher disease stage (adjusted odds ratio for stage III vs I, 16.0; 95% CI, 9.8–26.2; P<.0001), Medicaid/indigent insurance, lower income (by 2000 US Census tract), and younger age at diagnosis. Model performance was consistent between the training and validation cohorts. In sensitivity analyses, insurance type, low income, and young age were associated with rrTNBC among patients with stage I/II but not stage III disease. When comparing rrTNBC versus late relapse (>24 months), we found that insurance type and young age remained significant. Conclusions: Timing of relapse in TNBC is associated with stage of disease and distinct sociodemographic features, including insurance type, income, and age at diagnosis.

Submitted March 30, 2020; final revision received September 22, 2020; accepted for publication September 23, 2020. Published online March 10, 2021.

Author contributions: Study concept and design: Asad, Lin, Hassett, Stover. Data generation and coordination: Barcenas, Bleicher, Cohen, Javid, Levine, Lin, Moy, Niland, Wolff, Hassett, Stover. Writing – original draft: Asad, Stover. Writing – review and editing: All authors.

Disclosures: Dr. Lin has reported receiving grant/research support from Genentech, Array Biopharma, GlaxoSmithKline, Kadmon, and Novartis. The remaining authors reported that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by a grant from Susan G. Komen for the Cure (CCR17480903; D.G. Stover).

Correspondence: Daniel G. Stover, MD, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH 43210. Email: daniel.stover@osumc.edu

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