Are there differences in overall survival among older breast cancer patients by race and ethnicity?

IF 3.2 2区医学 Q1 SURGERY Surgery Pub Date : 2024-10-30 DOI:10.1016/j.surg.2024.06.085

Adrienne Nicole Cobb, Christine Rogers, Xiaowei Dong, Chiang-Ching Huang, Amanda L Kong, Chandler S Cortina

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Abstract

Background: Non-Hispanic Black women have lower breast cancer incidence but twice the mortality of non-Hispanic White women. Recent data suggest that the overall survival difference may not be observed in older women. This study aims to determine overall survival in women aged ≥70 years with operable breast cancer by race and ethnicity and factors contributing to overall survival.

Methods: The National Cancer Database was queried to identify women aged ≥70 years with stage 0-III breast cancer from 2004 to 2018. Patients were separated by race and ethnicity: non-Hispanic White, non-Hispanic Black, Hispanic, and Other. To examine overall survival, a Cox proportional hazards model was created, and overall survival was calculated using the Kaplan-Meier method.

Results: There were 304,345 eligible patients. The mean age was 76.8 years (standard deviation 5.5 years), and most were non-Hispanic White (85.2%), had Medicare (86.8%), had hormone receptor-positive breast cancer (78.7%), and underwent partial mastectomy (64.5%). Compared with non-Hispanic White women, non-Hispanic Black women had a higher prevalence of stage III disease (10.8% vs 7.5%, P < .001) and triple-negative breast cancer (16.7% vs 8.7% P < .001), and a longer time to treatment initiation (39.2 vs 32.3 days, P < .001). Median follow-up was 5.38 years (interquartile range: 3.83-7.46 years). Non-Hispanic Black women had the lowest median survival time compared with non-Hispanic White women (9.7 vs 10.4 years, P < .001). After adjusting for insurance type, receptor status, stage, comorbidity, time to treatment, and facility type, there was no increased risk of death for non-Hispanic Black patients (hazard ratio: 0.99, 95% confidence interval: 0.96-1.01, P = .29).

Conclusion: Although overall survival was lower in older non-Hispanic Black women, this difference resolved on multivariate modeling, suggesting that other factors likely influence overall survival for this cohort.

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不同种族和族裔的老年乳腺癌患者的总生存率是否存在差异？

背景：非西班牙裔黑人妇女的乳腺癌发病率较低，但死亡率却是非西班牙裔白人妇女的两倍。最近的数据表明，在老年妇女中可能观察不到总生存率的差异。本研究旨在按种族和族裔确定年龄≥70岁可手术乳腺癌女性的总生存率，以及影响总生存率的因素：通过查询国家癌症数据库，确定2004年至2018年期间≥70岁患有0-III期乳腺癌的女性。患者按种族和民族分类：非西班牙裔白人、非西班牙裔黑人、西班牙裔和其他。为考察总生存率，建立了一个考克斯比例危险模型，并使用卡普兰-梅耶法计算总生存率：符合条件的患者有 304345 人。平均年龄为 76.8 岁（标准偏差为 5.5 岁），大多数为非西班牙裔白人（85.2%），拥有医疗保险（86.8%），患有激素受体阳性乳腺癌（78.7%），并接受了部分乳房切除术（64.5%）。与非西班牙裔白人妇女相比，非西班牙裔黑人妇女的 III 期疾病患病率更高（10.8% 对 7.5%，P < .001），三阴性乳腺癌患病率更高（16.7% 对 8.7%，P < .001），开始治疗的时间更长（39.2 天对 32.3 天，P < .001）。中位随访时间为 5.38 年（四分位间范围：3.83-7.46 年）。与非西班牙裔白人女性相比，非西班牙裔黑人女性的中位生存时间最短（9.7 年 vs 10.4 年，P < .001）。在对保险类型、受体状态、分期、合并症、治疗时间和医疗机构类型进行调整后，非西班牙裔黑人患者的死亡风险没有增加（危险比：0.99，95% 置信区间：0.96-1.01，P = .29）：结论：虽然非西班牙裔黑人老年妇女的总生存率较低，但这一差异在多变量建模中消失了，这表明其他因素可能会影响该群体的总生存率。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.