Wu Xiaocheng, Richardson Lisa C, Kahn Amy R, Fulton John P, Cress Rosemary D, Shen Tiefu, Wolf Holly J, Bolick-Aldrich Susan, Chen Vivien W
Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
J Natl Med Assoc. 2008 May;100(5):490-8. doi: 10.1016/s0027-9684(15)31295-5.
This study examined the impact of guideline-concordant therapy on the survival difference between non-Hispanic black (NHB) and non-Hispanic white (NHW) women with localized breast cancer.
Data analyzed were from the CDC's NPCR Patterns of Care study in which seven population-based state cancer registries participated. We randomly selected 2,362 women who were diagnosed with a first primary localized breast cancer in 1997. Data were abstracted from hospital records, supplemented by information from physician offices and by linkages with state vital records and the National Death Index database.
NHB women were more likely than NHW women to receive breast conserving surgery without radiation therapy. In addition, the percentage of NHB women with hormone receptor-positive tumors who received hormonal therapy was lower than that of NHW women. Among those with a tumor size > 3 cm, NHB women were more likely than NHW women to receive multiagent chemotherapy. After controlling for age, the risk of dying from all causes of death was 2.35 times as high for NHB women compared to NHW women. Controlling for treatment further reduced black-white difference in survival with adjustment for sociodemographic and clinical variables.
NHB women were less likely than NHW women to receive guideline-concordant radiation therapy after breast conserving therapy and hormonal therapy but were more likely to receive chemotherapy. Racial differences in treatment contribute significantly to the worse survival of NHB women compared with NHW women.
本研究探讨了符合指南的治疗对患有局部乳腺癌的非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）女性生存差异的影响。
分析的数据来自疾病预防控制中心的国家癌症发病率与治疗模式研究（NPCR），该研究有七个基于人群的州癌症登记处参与。我们随机选择了1997年被诊断为原发性局部乳腺癌的2362名女性。数据从医院记录中提取，并辅以医生办公室的信息以及与州生命记录和国家死亡指数数据库的关联信息。
与NHW女性相比，NHB女性更有可能接受保乳手术且不进行放射治疗。此外，激素受体阳性肿瘤的NHB女性接受激素治疗的比例低于NHW女性。在肿瘤大小>3 cm的患者中，NHB女性比NHW女性更有可能接受多药化疗。在控制年龄后，NHB女性的全因死亡风险是NHW女性的2.35倍。通过控制治疗并调整社会人口统计学和临床变量，进一步缩小了黑人和白人在生存方面的差异。
与NHW女性相比，NHB女性在接受保乳治疗和激素治疗后接受符合指南的放射治疗的可能性较小，但接受化疗的可能性较大。治疗方面的种族差异显著导致NHB女性的生存情况比NHW女性更差。
