Breast
Nicci Owusu-Brackett, MD
Complex General Surgical Oncology Fellow
Ohio State University
Disclosure: Disclosure information not submitted.
Rapid relapse triple negative breast cancer (rrTNBC) is defined as mortality within 24 months of diagnosis in non-metastatic patients. There are currently no studies evaluating contributors to rapid relapse among Non-Hispanic Black (NHB) women despite higher rates of TNBC and poor oncologic outcomes. The objective of this study is to examine the relationship between surgical management, sociodemographic factors, and clinical characteristics on rapid relapse among NHB women presenting with TNBC.
Methods:
NHB women diagnosed with stages I to III TNBC from 01/01/2010–12/31/2017 were identified in the National Cancer Database (NCDB). The sample was grouped into rrTNBC vs non-rrTNBC. Surgical delay was defined as surgery >60 days after diagnosis. Bivariable and multivariable analysis (OR, 95%CI) were used to evaluate the association between rapid relapse, sociodemographic factors, clinical variables, and surgery.
Results:
Of the 31,471 patients in the study, 9.34% had rrTNBC. The rrTNBC group was older (59.4years±14.60 vs 56.6years±12.4; p< 0.01), lived in low-income areas (42.8% vs 37.9%; p< 0.01), Medicaid/uninsured (21.9% vs 17.3%; p< 0.01), and had advanced disease (stage 3 36.4% vs 11.7%; p< 0.01) compared to non-rrTNBC patients. There was no difference in surgical delay between the groups (16.8% vs 15.9%; p=0.42). Notably, rrTNBC patients were more likely to have surgery omitted (31.7% vs 22.1%; p< 0.01). On adjusted analysis, residing in low-income areas (1.37, 1.10-1.71; p=0.005), Medicaid (1.33, 1.14-1.56; p< 0.01) or Medicare (1.66, 1.35-2.02; p< 0.01) insurance, advanced stage (stage 3 7.52, 6.36-8.91; p< 0.001) and multiple comorbidities (≥2 comorbidities 1.85, 1.52-2.23; p< 0.01) were associated with rapid relapse. There was no association between surgical delay and rapid relapse (p=0.45). On subset analysis, major contributors to the model were insurance (15%) and tumor characteristics (80%).
Conclusions: Despite disparities in surgery utilization, tumor characteristics and insurance are the major drivers of rapid relapse in NHB with TNBC. Future interventions for rrTNBC should target tumor genomics and social determinants of health.