Published in:
01-05-2016 | Original paper
Mortality risk from comorbidities independent of triple-negative breast cancer status: NCI-SEER-based cohort analysis
Authors:
Helen Swede, Amna Sarwar, Anil Magge, Dejana Braithwaite, Linda S. Cook, David I. Gregorio, Beth A. Jones, Jessica R. Hoag, Lou Gonsalves, Andrew L. Salner, Kristen Zarfos, Biree Andemariam, Richard G. Stevens, Alicia G. Dugan, Mellisa Pensa, Jessica A. Brockmeyer
Published in:
Cancer Causes & Control
|
Issue 5/2016
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Abstract
Purpose
A comparatively high prevalence of comorbidities among African-American/Blacks (AA/B) has been implicated in disparate survival in breast cancer. There is a scarcity of data, however, if this effect persists when accounting for the adverse triple-negative breast cancer (TNBC) subtype which occurs at threefold the rate in AA/B compared to white breast cancer patients.
Methods
We reviewed charts of 214 white and 202 AA/B breast cancer patients in the NCI-SEER Connecticut Tumor Registry who were diagnosed in 2000–2007. We employed the Charlson Co-Morbidity Index (CCI), a weighted 17-item tool to predict risk of death in cancer populations. Cox survival analyses estimated hazard ratios (HRs) for all-cause mortality in relation to TNBC and CCI adjusting for clinicopathological factors.
Results
Among patients with SEER local stage, TNBC increased the risk of death (HR 2.18, 95 % CI 1.14–4.16), which was attenuated when the CCI score was added to the model (Adj. HR 1.50, 95 % CI 0.74–3.01). Conversely, the adverse impact of the CCI score persisted when controlling for TNBC (Adj. HR 1.49, 95 % CI 1.29–1.71; per one point increase). Similar patterns were observed in SEER regional stage, but estimated HRs were lower. AA/B patients with a CCI score of ≥3 had a significantly higher risk of death compared to AA/B patients without comorbidities (Adj. HR 5.65, 95 % CI 2.90–11.02). A lower and nonsignificant effect was observed for whites with a CCI of ≥3 (Adj. HR 1.90, 95 % CI 0.68–5.29).
Conclusions
comorbidities at diagnosis increase risk of death independent of TNBC, and AA/B patients may be disproportionately at risk.