Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 18, 2022
Date Accepted: Oct 18, 2022
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Stage-specific Survival in Breast Cancer between Chinese and White Women: An Surveillance, Epidemiology, and End Results Data Analysis
ABSTRACT
Background:
The stage-specific survival according to the 8th breast cancer (BC) American Joint Committee on Cancer (AJCC) pathological prognostic staging (PPS) between Chinese and White American (WA) women remains unclear.
Objective:
To assess the stage-specific survival in BC between Chinese and WA women according to the 8th AJCC PPS.
Methods:
We included Chinese and WA patients with BC diagnosed between 2010 and 2018 from the Surveillance, Epidemiology, and End Results database. Chi-square test, Kaplan-Meier method, receiver operating curve (ROC), and multivariate cox proportional hazards models were used for data analysis.
Results:
We included 376,818 patients in this study, including 369,522 WA and 7,296 Chinese. Of these patients, 39.7% migrated from the 7th AJCC anatomical stage (AS) to the 8th AJCC PPS, 6% of patients were upstaged and 33.7% of patients were downstaged. With a median follow-up time of 44 months, the 5-year overall survival and cancer-specific survival (CSS) for the entire group were 87.4% and 95.9%, respectively. The 7th AJCC AS (P < .001) and the 8th AJCC PPS (P < .001) could significantly predict the survival outcomes of BC, and the multivariate analysis showed that both staging systems were significant prognostic indicators of CSS. ROC curve showed that the PPS had a better discriminating ability than the AS [the area under the curve (AUC) 0.769 vs. 0.753, P < .001]. Similar trends were observed after stratification by the two ethnic groups. The 8th PPS had better discriminating ability compared with the 7th AS both in WA (AUC 0.769 vs. 0.753, P < .001) and Chinese patients (AUC 0.790 vs. 0.776, P < .001). In the 7th AS, Chinese women had better CSS in stage IA (P = .02), stage IIA (P = .005), and stage IIIB (P = .04) diseases compared with WA women, while no significance in CSS was observed in stage IB, IIB, IIIA, and IIIC between the two ethnic groups. Regarding the 8th PPS, Chinese women had better CSS in stage IA (P = .002) and IIIA (P = .046) diseases compared with WA patients, while there were similar CSS between Chinese and WA women in other substages.
Conclusions:
The 8th PPS has a similar discriminative ability between WA and Chinese BC patients compared with the 7th AS. Therefore, the PPS is also applicable to Chinese patients with BC.
Citation
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