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

Abstract

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.

Real-world clinical and survival outcomes of patients with early relapsed triple-negative breast cancer from the ESME national cohort

“…As the ESME cohort focuses on patients with metastatic breast cancer, information on localized stage is often lacking, such as initial staging, specific treatment received such as platinum and biology as well as socioeconomic data, which limits analysis of predictors from early relapse. However, these factors have already been widely demonstrated in two previous cohorts (29,30). Also, several data, especially pathological and biological, are not present in ESME.…”

Survival according to the site of metastasis in triple-negative breast cancer patients: The Peruvian experience

“…TNBC patients are less likely to be diagnosed in a screening mammography, leading to diagnosis being made at a more advance stage [ 11 , 14 ]. Moreover, In Latin America most cases are diagnosed in advanced stages due to the serious problem of limited access to breast cancer screenings in these countries [ 15 , 16 ] Asad et al found that the stage at diagnosis was the most significant factor for the rapid development of relapse of TNBC; with 55% of patients with stage III TNBC at diagnosis developing relapse, demonstrating a 15-fold higher probability of relapse compared to women with stage I [ 17 ]. The majority of our patients (78.1%) have a histologic grade III.…”

Characteristics of recurrence, predictors for relapse and prognosis of rapid relapse triple-negative breast cancer

“…Sociodemographic factor analysis by Daniel G. Stover et al. found that RR-TNBC patients were associated with Medicaid/indigent insurance, being single, of Black ethnicity, having a lower income, and a younger age at diagnosis ( 28 , 29 ). Due to a lack of data, we did not focus on the analysis of many sociodemographic factors.…”