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The Will Rogers phenomenon, breast cancer and race

BACKGROUND: The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases...

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Autores principales: Nittala, Mary R., Mundra, Eswar K., Packianathan, S., Mehta, Divyang, Smith, Maria L., Woods, William C., McKinney, Shawn, Craft, Barbara S., Vijayakumar, Srinivasan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127271/
https://www.ncbi.nlm.nih.gov/pubmed/34001038
http://dx.doi.org/10.1186/s12885-021-08125-8
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author Nittala, Mary R.
Mundra, Eswar K.
Packianathan, S.
Mehta, Divyang
Smith, Maria L.
Woods, William C.
McKinney, Shawn
Craft, Barbara S.
Vijayakumar, Srinivasan
author_facet Nittala, Mary R.
Mundra, Eswar K.
Packianathan, S.
Mehta, Divyang
Smith, Maria L.
Woods, William C.
McKinney, Shawn
Craft, Barbara S.
Vijayakumar, Srinivasan
author_sort Nittala, Mary R.
collection PubMed
description BACKGROUND: The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP. METHODS: This is a retrospective analysis of 300 BC women (2007–2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes. RESULTS: Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004). CONCLUSION: The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.
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spelling pubmed-81272712021-05-18 The Will Rogers phenomenon, breast cancer and race Nittala, Mary R. Mundra, Eswar K. Packianathan, S. Mehta, Divyang Smith, Maria L. Woods, William C. McKinney, Shawn Craft, Barbara S. Vijayakumar, Srinivasan BMC Cancer Research Article BACKGROUND: The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP. METHODS: This is a retrospective analysis of 300 BC women (2007–2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes. RESULTS: Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004). CONCLUSION: The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data. BioMed Central 2021-05-17 /pmc/articles/PMC8127271/ /pubmed/34001038 http://dx.doi.org/10.1186/s12885-021-08125-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Nittala, Mary R.
Mundra, Eswar K.
Packianathan, S.
Mehta, Divyang
Smith, Maria L.
Woods, William C.
McKinney, Shawn
Craft, Barbara S.
Vijayakumar, Srinivasan
The Will Rogers phenomenon, breast cancer and race
title The Will Rogers phenomenon, breast cancer and race
title_full The Will Rogers phenomenon, breast cancer and race
title_fullStr The Will Rogers phenomenon, breast cancer and race
title_full_unstemmed The Will Rogers phenomenon, breast cancer and race
title_short The Will Rogers phenomenon, breast cancer and race
title_sort will rogers phenomenon, breast cancer and race
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127271/
https://www.ncbi.nlm.nih.gov/pubmed/34001038
http://dx.doi.org/10.1186/s12885-021-08125-8
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