EPR20-075: Clinicopathological Features as a Predictor of Female Triple-Negative Breast Cancer Metastasis and Survival in the United States, 2010-2015: a Logistic Regression Model From NCI Surveillance, Epidemiology and End Results (SEER) Database

Authors: Zikun Wang MPH a , Zheyu Lu MD b , Zhongxue Chen PhD a and Yi Dong MD, PhD c
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  • a Indiana University Bloomington, Bloomington, IN
  • b Ball Memorial Hospital, Indiana University Health, Muncie, IN
  • c Indiana University School of Medicine, Indianapolis, IN

Background: Triple-negative breast cancer (TNBC) is a group of heterogeneous diseases with aggressive nature and poor survival (worst in metastatic disease). But It is not well defined how risk factors impact the distant metastasis and survival of TNBC. Methods: 23,848 female TNBC patients were enrolled from NCI SEER 18 program, including 536 distant metastatic cases. Only patients without missing clinicopathological information were included: age, race, marital status, histology, AJCC 7th Edition T, N, M and stage, grade, follow-up for vital status and metastatic status. A logistic regression model was used to study risk factors for 1) distant metastasis and their correlation with specific organ involvement and 2) multiple (≥2) sites versus (vs.) single site of spreading. Kaplan-Meier Survival analysis was done to compare the TNBC-specific survival (TNBCSS) rate. Results: Younger age (≤49) decreased the rate of metastasis: 2.0% vs. 2.5% in 50-64 group (reference [ref]), odds ratio (OR) (95%CI): 0.69 (0.55-0.87). However, ≤49 patients had significantly worse TNBCSS rate: 79.7% vs. 81.3%, hazard ratio (HR) (95% CI): 1.14 (1.05-1.25). Metastatic rate in single patients was not elevated: 2.6% vs. 1.9% in married women (ref), OR (95%CI): 0.95 (0.74-1.22); however, single patients had significantly lower TNBCSS rate: 77.3% vs. 82.1%, HR (95%CI): 1.42 (1.30-1.56). Black race did not increase metastatic rate: 2.9% vs. 2.1% in non-Hispanic white women (ref), OR (95%CI): 1.14 (0.91-1.43); but black women had significantly worse TNBCSS rate: 77.6% vs. 81.0%, HR (95%CI): 1.25 (1.15-1.36). TNBC patients with larger tumor size (T2-T4 vs. T1) and advanced node involvement (N1-N3 vs. N0) significantly increased the risk of metastasis to solid organs, e.g., bone, brain, lung and liver. But no statistically significant risk factors were found as a predictor of dissemination to multiple sites due to the small sample size (N=198). Conclusions: Younger age decreased, and single status and black race did not increase the risk of metastasis, but they all had lower TNBCSS rate, compared with reference cohorts. These findings suggest that there are other survival-impacting factors yet to be established. TNBC patients with characteristics (e.g., larger tumor size and advanced node involvement) are correlated with increased risk of metastasis to solid organs (Table 1). Specific registry is required to study risk factors for multiple organ metastases.


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Corresponding Author: Yi Dong, MD, PhD
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