接受蒽环类和紫杉类新辅助化疗的乳腺癌患者的病理完全缓解：评估种族/民族的影响。
Pathologic complete response in breast cancer patients receiving anthracycline- and taxane-based neoadjuvant chemotherapy: evaluating the effect of race/ethnicity.
机构信息
Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
出版信息
Cancer. 2010 Sep 1;116(17):4168-77. doi: 10.1002/cncr.25296.
BACKGROUND
The current study was conducted to evaluate the influence of race/ethnicity and tumor subtype in pathologic complete response (pCR) following treatment with neoadjuvant chemotherapy.
METHODS
A total of 2074 patients diagnosed with breast cancer between 1994 and 2008 who were treated with neoadjuvant anthracycline- and taxane-based chemotherapy were included. pCR was defined as no residual invasive cancer in the breast and axilla. The Kaplan-Meier product-limit was used to calculate survival outcomes. Cox proportional hazards models were fitted to determine the relationship of patient and tumor variables with outcome.
RESULTS
The median patient age was 50 years; 14.6% of patients were black, were 15.2% Hispanic, 64.3% were white, and 5.9% were of other race. There were no differences in pCR rates among race/ethnicity (12.3% in black, 14.2% in Hispanics, 12.3% in whites, and 11.5% in others, P = .788). Lack of pCR, breast cancer subtype, grade 3 tumors, and lymphovascular invasion were associated with worse recurrence-free survival (RFS) and overall survival (OS) (P </= .0001). Differences in RFS by race/ethnicity were noted in the patients with hormone receptor-positive disease (P = .007). On multivariate analysis, Hispanics had improved RFS (hazard ratio [HR], 0.69; 95% confidence interval [95% CI], 0.49-0.97) and OS (HR, 0.63; 95% CI, 0.41-0.97); blacks had a trend toward worse outcomes (RFS: HR, 1.28 [95% CI, 0.97-1.68] and OS: HR, 1.32 [95% CI, 0.97-1.81]) when compared with whites.
CONCLUSIONS
In this cohort of patients, race/ethnicity was not found to be significantly associated with pCR rates. On a multivariate analysis, improved outcomes were observed in Hispanics and a trend toward worse outcomes in black patients, when compared with white patients. Further research was needed to explore the potential differences in biology and outcomes.
背景
本研究旨在评估种族/民族和肿瘤亚型对新辅助化疗后病理完全缓解（pCR）的影响。
方法
共纳入 1994 年至 2008 年间接受新辅助蒽环类和紫杉类化疗的 2074 例乳腺癌患者。pCR 定义为乳腺和腋窝无残留浸润性癌。采用 Kaplan-Meier 乘积限法计算生存结果。Cox 比例风险模型用于确定患者和肿瘤变量与结局的关系。
结果
患者中位年龄为 50 岁；14.6%的患者为黑人，15.2%为西班牙裔，64.3%为白人，5.9%为其他种族。不同种族/民族之间的 pCR 率无差异（黑人 12.3%，西班牙裔 14.2%，白人 12.3%，其他种族 11.5%，P=0.788）。无 pCR、乳腺癌亚型、3 级肿瘤和脉管侵犯与无复发生存（RFS）和总生存（OS）较差相关（P≤0.0001）。在激素受体阳性疾病患者中，种族/民族对 RFS 的影响存在差异（P=0.007）。多变量分析显示，与白人相比，西班牙裔患者 RFS（风险比 [HR]，0.69；95%置信区间 [95%CI]，0.49-0.97）和 OS（HR，0.63；95%CI，0.41-0.97）均改善；与白人相比，黑人患者的 RFS（HR，1.28[95%CI，0.97-1.68]）和 OS（HR，1.32[95%CI，0.97-1.81]）均有趋势较差。
结论
在本队列患者中，种族/民族与 pCR 率无显著相关性。多变量分析显示，与白人相比，西班牙裔患者结局改善，黑人患者结局有趋势较差。需要进一步研究以探讨生物学和结局的潜在差异。
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