Abstract P5-12-08: Survival differences by stage and race/ethnicity using the Nottingham prognostic index

Abstract

Abstract Background It is well documented that race/ethic disparities in breast cancer survival exist. The Nottingham Prognostic Index (NPI), based on tumor size, lymph node status, and histologic grade, is a well established method of predicting survival of operable breast cancer. The purpose of this investigation is to determine if race/ethnic disparities also exist among the NPI categories. Method We identified 157, 865 cases of stages 1-3 first primary female invasive breast cancer from the California Cancer Registry diagnosed between January 1, 2000 and December 31, 2010. The NPI was computed and cases were stratified as having good (NPI <3.4), moderate (3.4-5.4) and poor (> 5.4) prognosis. Kaplan Meier Survival analysis (95% CIs) was used to compare survival at eight years for patients who were white, black, Hispanic, or Asian/Pacific Islander (API) within each AJCC stage and NPI category. Results The distribution of cases by stage, race/ethnicity and good, moderate, and poor NPI categories is seen in the table. Distribution of cases by stage, race/ethnicity and NPI categories WhiteBlackHispanicAPITotalStage 1 Good15,8287442,4432,16921,184Moderate28,9841,8025,1954,20040,181Poor9,7701,0152,4351,85515,075Stage 2 Good237234842350Moderate4,0872567315155,589Poor37,1094,00710,8937,18659,195Stage 3 Good803112Moderate56216983Poor9,4511,2793,7021,76416,196Total 157,865 Stage 1: There were no significant differences in survival within the good category. In the moderate category, APIs (95.5; 94.5, 96.6) had better survival than whites (93.6; 93.2, 94.0) whereas blacks (90.1; 87.8; 92.3) had worse survival. In the poor NPI category, APIs (92.6; 90.8, 94.4) also had better survival than whites (88.7; 87.8, 89.6). Stage 2: In the moderate NPI category, blacks (92.8; 89.0, 96.7) had worse survival than whites (94.0; 93.0, 95.1) and in the poor category, blacks (73.8; 71.9, 75.8) and Hispanics (80.7; 79.5, 81.8) both had worse survival than whites (81.8; 81.2, 82.3) while APIs had better survival (84.6; 83.3, 85.8). Stage 3: There were too few patients in the good and moderate NPI categories. In the poor category, blacks (47.8, 43.4, 52.1) had worse survival than whites (60.1; 58.4, 61.8) while APIs (64.2; 60.2, 68.2) had better survival. Conclusion The NPI provides further refinement of the disparities in survival among race/ethnicity. It appears that APIs have better survival than whites in all stages of disease. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-12-08.