Table 3.
Multivariable Analysis of Factors Associated with Upgrade by the American Joint Committee on Cancer 8th Edition Prognostic Staging
| Patient characteristic | ER+ DCIS |
ER– DCIS |
NET |
Primary operation |
||||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | p Value | OR (95% CI) | p Value | OR (95% CI) | p Value | OR (95% CI) | p Value | |
| Age | ||||||||
| 18–39 y | Too few events | — | Too few events | — | Too few events | — | Too few events | — |
| 40–49 y | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| 50–59 y | 1.00 (0.94–1.07) | 0.99 | (0.77 0.68–0.87) | < 0.01 | (0.84 0.50–01.40) | 0.50 | (1.00 0.96–1.05) | 0.90 |
| 60–69 y | 1.05 (0.98–1.13) | 0.19 | (0.67 0.59–0.78) | < 0.01 | (0.61 0.35–1.06) | 0.08 | (0.87 0.83–0.92) | < 0.01 |
| 70–79 y | 1.14 (1.03–1.25) | 0.01 | (0.64 0.53–0.78) | < 0.01 | (0.81 0.44–1.51) | 0.51 | (0.84 0.79–0.89) | < 0.01 |
| 80 y or older | 1.32 (1.15–1.51) | < 0.01 | (0.61 0.47–0.78) | < 0.01 | (1.56 0.82–2.98) | 0.17 | (1.22 1.13–1.32) | < 0.01 |
| Race | ||||||||
| White | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| Black | 0.98 (0.91–1.05) | 0.49 | (1.26 1.10–1.45) | < 0.01 | (1.27 0.78–2.10) | 0.34 | (1.46 1.38–1.53) | < 0.01 |
| Hispanic | 1.12 (1.01–1.24) | 0.03 | (1.08 0.89–1.30) | 0.45 | (1.19 0.65–2.18) | 0.58 | (1.19 1.11–1.27) | < 0.01 |
| Asian | 1.22 (1.09–1.36) | < 0.01 | (1.41 1.15–1.71) | < 0.01 | (0.92 0.39–2.18) | 0.85 | (0.93 0.85–1.01) | 0.10 |
| Comorbidity index | ||||||||
| 0 | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| 1 | 1.13 (1.05–1.21) | < 0.01 | (1.13 0.99–1.29) | 0.06 | (0.94 0.60–1.45) | 0.76 | (1.05 1.01–1.10) | 00.02 |
| 2 | 1.33 (1.14–1.54) | < 0.01 | (1.27 0.97–1.67) | 0.08 | (1.21 0.62–2.38) | 0.58 | (1.13 1.03–1.24) | 0.01 |
| ≥ 3 | 1.36 (1.05–1.76) | 0.02 | (1.26 0.73–2.16) | 0.40 | (1.92 0.85–4.31) | 0.11 | (1.12 0.95–1.31) | 0.18 |
| Insurance | ||||||||
| Private | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| Medicare | 0.93 (0.87–0.99) | 0.04 | 0.93 0.81–1.06) | 0.27 | (1.54 0.99–2.37) | 0.06 | (0.98 0.93–1.02) | 0.31 |
| Medicaid | 1.06 (0.95–1.18) | 0.28 | 1.30 1.08–1.57) | 0.01 | (1.69 0.97–2.95) | 0.06 | (1.27 1.19–1.36) | < 0.01 |
| Uninsured | 0.90 (0.74–1.09) | 0.28 | 0.84 0.60–1.18) | 0.31 | (0.55 0.12–2.44) | 0.43 | (1.28 1.13–1.44) | < 0.01 |
| Facility type | ||||||||
| Community | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| Comprehensive | 1.26 (1.14–1.38) | < 0.01 | (1.26 1.05–1.52) | < 0.01 | (1.60 0.80–3.20) | 0.18 | (0.96 0.91–1.02) | 0.17 |
| Academic | 1.53 (1.38–1.69) | < 0.01 | (1.81 1.49–2.19) | < 0.01 | (1.81 0.91–3.63) | 0.09 | (0.96 0.90–1.02) | 0.15 |
| Integrated network | 1.29 (1.15–1.44) | < 0.01 | (1.54 1.25–1.89) | < 0.01 | (1.64 0.79–3.44) | 0.19 | (0.91 0.86–0.97) | 0.01 |
| Histology | ||||||||
| Ductal | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| Lobular | NA | — | NA | — | (1.75 1.21–2.53) | < 0.01 | (1.50 1.44–1.57) | < 0.01 |
| Mixed | 0.13 (0.12–0.14) | < 0.01 | (0.08 0.06–0.10) | < 0.01 | (1.25 0.80–1.96) | 0.32 | (1.13 1.08–1.19) | < 0.01 |
| cT | ||||||||
| cT1 | NA all cTis | — | — | — | 1 | Ref | 1 | Ref |
| cT2 | — | — | — | — | (0.36 0.26–0.50) | < 0.01 | (0.47 0.45–0.49) | < 0.01 |
| Operation type | ||||||||
| BCS | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| Mastectomy | 2.76 (2.63–2.90) | < 0.01 | (2.14 1.96–2.35) | < 0.01 | (3.07 2.26–4.17) | < 0.01 | (2.82 2.73–2.91) | < 0.01 |
| Operation timing | ||||||||
| <60 d | 1 | Ref | 1 | Ref | 1 | Ref | 1 | Ref |
| 60–120 d | 1.15 (1.08–1.22) | < 0.01 | (1.09 0.97–1.23) | 0.14 | (1.01 0.64–1.61) | 0.96 | (0.92 0.88–0.97) | < 0.01 |
| > 120 d | 1.44 (1.24–1.68) | < 0.01 | (1.36 1.01–1.82) | 0.04 | (1.46 0.94–2.29) | 0.09 | (1.06 0.90–1.25) | 0.48 |
BCS, breast-conserving surgery; cT, clinical tumor category, DCIS, ductal carcinoma in situ; ER, estrogen receptor; NA, not applicable; NET, neoadjuvant endocrine therapy; OR, odds ratio; Ref, reference.