Ohio State University Wexner Medical Center, Columbus, Ohio.
MD Anderson Cancer Center, Houston, Texas.
J Natl Compr Canc Netw. 2021 Mar 10;19(7):797-804. doi: 10.6004/jnccn.2020.7659.
Triple-negative breast cancer (TNBC) accounts for disproportionately poor outcomes in breast cancer, driven by a subset of rapid-relapse TNBC (rrTNBC) with marked chemoresistance, rapid metastatic spread, and poor survival. Our objective was to evaluate clinicopathologic and sociodemographic features associated with rrTNBC.
We included patients diagnosed with stage I-III TNBC in 1996 through 2012 who received chemotherapy at 1 of 10 academic cancer centers. rrTNBC was defined as a distant metastatic recurrence event or death ≤24 months after diagnosis. Features associated with rrTNBC were included in a multivariable logistic model upon which backward elimination was performed with a P<.10 criterion, with a final multivariable model applied to training (70%) and independent validation (30%) cohorts.
Among all patients with breast cancer treated at these centers, 3,016 fit the inclusion criteria. Training cohort (n=2,112) bivariable analyses identified disease stage, insurance type, age, body mass index, race, and income as being associated with rrTNBC (P<.10). In the final multivariable model, rrTNBC was significantly associated with higher disease stage (adjusted odds ratio for stage III vs I, 16.0; 95% CI, 9.8-26.2; P<.0001), Medicaid/indigent insurance, lower income (by 2000 US Census tract), and younger age at diagnosis. Model performance was consistent between the training and validation cohorts. In sensitivity analyses, insurance type, low income, and young age were associated with rrTNBC among patients with stage I/II but not stage III disease. When comparing rrTNBC versus late relapse (>24 months), we found that insurance type and young age remained significant.
Timing of relapse in TNBC is associated with stage of disease and distinct sociodemographic features, including insurance type, income, and age at diagnosis.
三阴性乳腺癌（TNBC）在乳腺癌中的预后较差，其部分原因是存在快速复发的 TNBC（rrTNBC），这种亚型具有明显的化疗耐药性、快速转移扩散和较差的生存情况。我们的目的是评估与 rrTNBC 相关的临床病理和社会人口统计学特征。
我们纳入了 1996 年至 2012 年期间在 10 个学术癌症中心接受化疗治疗的 I-III 期 TNBC 患者。rrTNBC 的定义为远处转移复发事件或诊断后≤24 个月内死亡。将与 rrTNBC 相关的特征纳入多变量逻辑模型，然后采用向后消除法进行分析，以 P<.10 为标准进行筛选，最后将多变量模型应用于训练（70%）和独立验证（30%）队列。
在这些中心治疗的所有乳腺癌患者中，有 3016 名符合纳入标准。训练队列（n=2112）的双变量分析确定疾病分期、保险类型、年龄、体重指数、种族和收入与 rrTNBC 相关（P<.10）。在最终的多变量模型中，rrTNBC 与较高的疾病分期（III 期与 I 期的调整优势比，16.0；95%置信区间，9.8-26.2；P<.0001）、医疗补助/贫困保险、较低收入（按 2000 年美国人口普查区划分）和诊断时的年龄较小显著相关。模型在训练和验证队列中的表现一致。在敏感性分析中，在 I/II 期疾病患者中，保险类型、低收入和年轻年龄与 rrTNBC 相关，但在 III 期疾病患者中则不然。当比较 rrTNBC 与晚期复发（>24 个月）时，我们发现保险类型和年龄仍然是显著相关的。
TNBC 复发的时间与疾病分期和不同的社会人口统计学特征相关，包括保险类型、收入和诊断时的年龄。
