Abstract
PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown (<1%). One hundred eighty six (21%) patients were pathologically node positive. There were 354 AA (40%) and 538 white
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Citation Formats
Campbell, T, Heimann, R, Powers, C, Vijayakumar, S, Ewing, C, Halpern, H, Michel, A, Rubin, S, and Weichselbaum, R.
Influence of race on outcome in patients treated with breast conserving therapy.
United States: N. p.,
1995.
Web.
doi:10.1016/0360-3016(95)97908-J.
Campbell, T, Heimann, R, Powers, C, Vijayakumar, S, Ewing, C, Halpern, H, Michel, A, Rubin, S, & Weichselbaum, R.
Influence of race on outcome in patients treated with breast conserving therapy.
United States.
https://doi.org/10.1016/0360-3016(95)97908-J
Campbell, T, Heimann, R, Powers, C, Vijayakumar, S, Ewing, C, Halpern, H, Michel, A, Rubin, S, and Weichselbaum, R.
1995.
"Influence of race on outcome in patients treated with breast conserving therapy."
United States.
https://doi.org/10.1016/0360-3016(95)97908-J.
@misc{etde_20420758,
title = {Influence of race on outcome in patients treated with breast conserving therapy}
author = {Campbell, T, Heimann, R, Powers, C, Vijayakumar, S, Ewing, C, Halpern, H, Michel, A, Rubin, S, and Weichselbaum, R}
abstractNote = {PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown (<1%). One hundred eighty six (21%) patients were pathologically node positive. There were 354 AA (40%) and 538 white (60%) patients. The chi-square test was used to compare distribution of prognostic factors between races. Outcome was evaluated by Kaplan-Meier actuarial method and logrank test. Sub-groups analyzed for outcome differences by race included T stage, tumor size, nodal status, grade, receptor status, age, menopausal status and family history. Multivariate analysis was performed by Cox proportional hazard model. RESULTS: No significant differences between AA and whites were seen in age, menopausal status, family history, T stage, N stage, number of nodes involved, histologic grade, total RT dose or chemotherapy. However, a larger percentage of whites received tamoxifen (43 vs 27%)(p<0.001), had low nuclear grade (19 vs 9%)(p<0.001), and more commonly had receptor positive tumors: ER (44 vs 32%)(p=0.001), PR (39 vs 28%)(p=0.002). More AA had tumors >4cm (5 vs 1%)(p=0.001) or were unknown size (10 vs 6%)(p=.001). Comparing AA and whites yielded 5 yr actuarial LC (94 vs 94%)(p=0.380), DFS (83 vs 85%)(p=0.120), CSS (84 vs 85%)(p=0.201) and OS (77 vs 80%)(p=0.112). Multivariate analysis demonstrated that the number of positive nodes was the strongest predictor of OS (p<.001) and although race did not reach statistical significance as an independent prognostic factor, a trend was demonstrated (p=.106). Sub-group analysis of 186 patients with ER/PR negative tumors showed significantly worse DFS (75 vs 93%)(p=0.005), CSS (79 vs 91%)(p=0.021) and OS (76 vs 89%)(p=0.011) for AA patients. Race was demonstrated to be an independent prognostic factor by multivariate analysis in this sub-group (p=.024). No significant differences by race were apparent in patients grouped by tumor size, nodal status or in the other sub-groups analyzed. CONCLUSION: Statistically significant differences in outcome of AA and white patients treated with BCT at our center were not observed in the overall group; however, multivariate analysis demonstrated that race is a borderline independent prognostic factor. On sub-group analysis race was shown to be a statistically significant prognostic factor for patients with receptor negative tumors. This may be an influence accounting for the observed differences in the general population. We are developing a socio-economic surrogate to apply to our database for further study of this issue.}
doi = {10.1016/0360-3016(95)97908-J}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}
title = {Influence of race on outcome in patients treated with breast conserving therapy}
author = {Campbell, T, Heimann, R, Powers, C, Vijayakumar, S, Ewing, C, Halpern, H, Michel, A, Rubin, S, and Weichselbaum, R}
abstractNote = {PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown (<1%). One hundred eighty six (21%) patients were pathologically node positive. There were 354 AA (40%) and 538 white (60%) patients. The chi-square test was used to compare distribution of prognostic factors between races. Outcome was evaluated by Kaplan-Meier actuarial method and logrank test. Sub-groups analyzed for outcome differences by race included T stage, tumor size, nodal status, grade, receptor status, age, menopausal status and family history. Multivariate analysis was performed by Cox proportional hazard model. RESULTS: No significant differences between AA and whites were seen in age, menopausal status, family history, T stage, N stage, number of nodes involved, histologic grade, total RT dose or chemotherapy. However, a larger percentage of whites received tamoxifen (43 vs 27%)(p<0.001), had low nuclear grade (19 vs 9%)(p<0.001), and more commonly had receptor positive tumors: ER (44 vs 32%)(p=0.001), PR (39 vs 28%)(p=0.002). More AA had tumors >4cm (5 vs 1%)(p=0.001) or were unknown size (10 vs 6%)(p=.001). Comparing AA and whites yielded 5 yr actuarial LC (94 vs 94%)(p=0.380), DFS (83 vs 85%)(p=0.120), CSS (84 vs 85%)(p=0.201) and OS (77 vs 80%)(p=0.112). Multivariate analysis demonstrated that the number of positive nodes was the strongest predictor of OS (p<.001) and although race did not reach statistical significance as an independent prognostic factor, a trend was demonstrated (p=.106). Sub-group analysis of 186 patients with ER/PR negative tumors showed significantly worse DFS (75 vs 93%)(p=0.005), CSS (79 vs 91%)(p=0.021) and OS (76 vs 89%)(p=0.011) for AA patients. Race was demonstrated to be an independent prognostic factor by multivariate analysis in this sub-group (p=.024). No significant differences by race were apparent in patients grouped by tumor size, nodal status or in the other sub-groups analyzed. CONCLUSION: Statistically significant differences in outcome of AA and white patients treated with BCT at our center were not observed in the overall group; however, multivariate analysis demonstrated that race is a borderline independent prognostic factor. On sub-group analysis race was shown to be a statistically significant prognostic factor for patients with receptor negative tumors. This may be an influence accounting for the observed differences in the general population. We are developing a socio-economic surrogate to apply to our database for further study of this issue.}
doi = {10.1016/0360-3016(95)97908-J}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}