Morris Gloria J, Naidu Sashi, Topham Allan K, Guiles Fran, Xu Yihuan, McCue Peter, Schwartz Gordon F, Park Pauline K, Rosenberg Anne L, Brill Kristin, Mitchell Edith P
Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Cancer. 2007 Aug 15;110(4):876-84. doi: 10.1002/cncr.22836.
Breast carcinomas in African-American patients appear to be more aggressive than in Caucasian patients due to multifactorial differences.
The authors compiled pathology data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database regarding stage, histologic grade, and estrogen receptor (ER) expression in breast carcinomas diagnosed in 197,274 African-American and Caucasian patients between 1990 and 2000, and the same information, along with nuclear grade, Ki-67, c-erb-B2, and p53 expression, in 2230 African-American and Caucasian patients diagnosed at Thomas Jefferson University Hospital between 1995 and 2002. Immunohistochemical markers were assayed in paraffin-embedded, formalin-fixed tissue stained with hematoxylin and eosin using antibodies to these proteins, with differences in expression analyzed by the chisquare test.
In both databases, more African-American patients presented with advanced stage tumors and higher histologic (P < .001) and nuclear grade (P < .001) than Caucasian patients. African-American patients had less ER positivity (51.9% vs 63.1%; P < .001) but significantly higher Ki-67 (42.4% vs 28.7%; P < .001) and p53 expression (19.4% vs 13.1%; P < .05) than Caucasian patients with all stages of disease. In addition, the basal or "triple-negative" breast cancer phenotype was more common in African-American patients than in Caucasian patients (20.8% vs 10.4%; P < .0001), and was associated with higher histologic and nuclear grade (P < .0001).
African-American patients with breast carcinomas are more likely than Caucasian patients to present with tumors that are of a later stage and higher grade, with higher Ki-67 expression and more ER negativity, thereby highlighting a greater need for early screening among African-American women. Molecular studies that may explain these differences, and correlations with survival, have been proposed to identify therapeutic targets.
由于多方面的差异，非裔美国患者的乳腺癌似乎比白人患者的更具侵袭性。
作者收集了美国国立癌症研究所监测、流行病学和最终结果（SEER）数据库中1990年至2000年间确诊的197274例非裔美国和白人乳腺癌患者的病理数据，包括分期、组织学分级和雌激素受体（ER）表达情况；还收集了1995年至2002年间在托马斯·杰斐逊大学医院确诊的2230例非裔美国和白人患者的相同信息，以及核分级、Ki-67、c-erb-B2和p53表达情况。使用针对这些蛋白质的抗体，对苏木精和伊红染色的石蜡包埋、福尔马林固定组织进行免疫组化标记检测，通过卡方检验分析表达差异。
在两个数据库中，与白人患者相比，更多非裔美国患者出现晚期肿瘤，且组织学分级（P <.001）和核分级更高（P <.001）。在所有疾病分期中，非裔美国患者的ER阳性率较低（51.9%对63.1%；P <.001），但Ki-67表达（42.4%对28.7%；P <.001）和p53表达显著更高（19.4%对13.1%；P <.05）。此外，基底样或“三阴性”乳腺癌表型在非裔美国患者中比在白人患者中更常见（20.8%对10.4%；P <.0001），并且与更高的组织学和核分级相关（P <.0
