title: Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial.
abstract: BACKGROUND
  The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy.
  
  
  METHODS
  The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline- and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided.
  
  
  RESULTS
  Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P < .001) and a higher body mass index (median: 31.7 vs 27.4 kg/m(2); P < .001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086).
  
  
  CONCLUSIONS
  Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center-Weiler Division, 1825 Eastchester Rd, 2S-Rm 47, Bronx, NY 10461, USA. jsparano@montefiore.org
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Sparano
authors.forename: Molin
authors.initials: M
authors.lastname: Wang
authors.forename: Fengmin
authors.initials: F
authors.lastname: Zhao
authors.forename: Vered
authors.initials: V
authors.lastname: Stearns
authors.forename: Silvana
authors.initials: S
authors.lastname: Martino
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Ligibel
authors.forename: Edith A
authors.initials: EA
authors.lastname: Perez
authors.forename: Tom
authors.initials: T
authors.lastname: Saphner
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Wolff
authors.forename: George W
authors.initials: GW
authors.lastname: Sledge
authors.forename: William C
authors.initials: WC
authors.lastname: Wood
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Davidson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D018572:Disease-Free Survival; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D009367:Neoplasm Staging; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D043823:Taxoids