Tuamokumo Nimi L, Haffty Bruce G
Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8040, USA.
Cancer J. 2003 Jul-Aug;9(4):313-20. doi: 10.1097/00130404-200307000-00014.
The purpose of this study was to evaluate the prognostic significance of race in breast cancer patients treated with lumpectomy and radiation therapy.
Between 1973 and 1997, 1614 patients were treated with lumpectomy and radiation therapy at our institution. All patient data, including race, age, stage, pathology, treatment, and outcome variables, were entered into a computerized database. One hundred and one women were identified as African American, and 1513 were identified as white. A small number (22) of patients of Asian, Hispanic, or other ethnic groups were eliminated from analysis. A detailed cosmetic analysis was performed on a selected subset of 20 African-American patients and 20 white patients from the database. The two groups were intentionally matched by age, follow-up, adjuvant therapy, and breast size and were asked to participate in a detailed cosmetic evaluation.
As of September 2001, median follow-up was 14.5 years. African-American patients presented with an earlier age of onset than white patients (51.1 African-American patients vs 56.5 white). By age groups, 42.5% of African-American patients were older than 50 years, compared with 68.6% of white patients. African-American patients presented with larger tumors (mean pathological size, 1.87 cm in African-American patients vs 1.57 cm in white patients) and were more frequently estrogen receptor negative (51% estrogen receptor-negative African-American patients vs 37% estrogen receptor-negative white patients). However, nodal status was similar in the two populations (27% node-positive African-American patients vs 24% node-positive white patients). Given their younger age and estrogen receptor negativity, African-American patients were more likely to receive chemotherapy, whereas white patients were more likely to receive adjuvant tamoxifen. Despite the earlier age of onset and larger tumor size, there were no significant differences between the African-American and white populations with respect to overall survival (82% in the African-American population vs 79% in the white) or cause-specific survival at 10 years (88% in the African-American population vs 86% in the white). African-American patients had a significantly lower breast relapse-free rate at 10 years (81% in the African-American population vs 87% in the white). Although this may be in part related to the younger age in the African-American patients, a multivariate analysis including age, race, margin status, and treatment parameters revealed young age and African-American race to be significantly associated with local relapse. With respect to overall cosmetic outcome and all specific cosmetic measures (edema, fibrosis, and pigmentation), African-American patients fared more poorly than white patients. Overall cosmesis was good to excellent in 55% of African Americans, compared with 90% of whites.
Despite a younger age of onset and a larger tumor size, outcome in African-American patients was similar to that of white patients with respect to overall and cause-specific survival. The explanation for a slightly higher local relapse rate and poorer cosmetic result requires further investigation.
本研究旨在评估种族因素对接受保乳手术和放射治疗的乳腺癌患者预后的影响。
1973年至1997年间，我院对1614例患者实施了保乳手术和放射治疗。所有患者的数据，包括种族、年龄、分期、病理、治疗及预后变量，均录入计算机数据库。其中101例女性为非裔美国人，1513例为白人。少数（22例）亚洲、西班牙裔或其他种族患者被排除在分析之外。从数据库中选取20例非裔美国患者和20例白人患者组成一个子集，对其进行详细的美容分析。两组患者在年龄、随访时间、辅助治疗及乳房大小方面进行了有意匹配，并邀请他们参与详细的美容评估。
截至2001年9月，中位随访时间为14.5年。非裔美国患者的发病年龄早于白人患者（非裔美国患者为51.1岁，白人患者为56.5岁）。按年龄分组，42.5%的非裔美国患者年龄超过50岁，而白人患者的这一比例为68.6%。非裔美国患者的肿瘤较大（非裔美国患者的平均病理大小为1.87 cm，白人患者为1.57 cm），且雌激素受体阴性的比例更高（51%的非裔美国患者雌激素受体阴性，白人患者为37%）。然而，两组患者的淋巴结状态相似（27%的非裔美国患者淋巴结阳性，白人患者为24%）。鉴于非裔美国患者年龄较小且雌激素受体阴性，他们更有可能接受化疗，而白人患者更有可能接受辅助性他莫昔芬治疗。尽管非裔美国患者发病年龄较早且肿瘤较大，但在总生存率（非裔美国人群为82%，白人为79%）或10年病因特异性生存率方面，非裔美国人和白人之间没有显著差异（非裔美国人群为88%，白人为86%）。非裔美国患者10年的无乳腺复发率显著较低（非裔美国人群为81%，白人为87%）。虽然这可能部分与非裔美国患者年龄较小有关，但一项包括年龄、种族、切缘状态和治疗参数的多变量分析显示，年轻和非裔美国人种与局部复发显著相关。在总体美容效果和所有具体美容指标（水肿、纤维化和色素沉着）方面，非裔美国患者的情况比白人患者更差。55%的非裔美国人总体美容效果为良好至优秀，而白人的这一比例为90%。
尽管非裔美国患者发病年龄较小且肿瘤较大，但在总生存率和病因特异性生存率方面，其结果与白人患者相似。局部复发率略高和美容效果较差的原因需要进一步研究。
