Department of Community Medicine & Health Care, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
Clin Breast Cancer. 2011 Oct;11(5):332-41. doi: 10.1016/j.clbc.2011.04.004. Epub 2011 May 12.
Emerging research suggests a substantially greater prevalence of the adverse triple-negative (TN) subtype (human epidermal growth factor receptor [HER]2(-), estrogen receptor ER, and progesterone receptor [PR])(-)) among black patients with breast cancer. No reports however have been generated from a statewide cancer registry.
The study consisted of all black patients (N = 643) and a random sample of white patients (n = 719) diagnosed with primary invasive breast cancer (2000-2003) listed in the National Cancer Institute-Surveillance Epidemiology and End Results (NCI-SEER) Connecticut Tumor Registry (CTR). HER2 status was obtained from pathology reports submitted to the registry. Remaining data were obtained from the registry database.
TN tumors were more prevalent in black compared with white patients (30.8% vs. 11.2%, respectively; P < .001.) There was a 2-fold greater frequency of ER(-) and PR(-) phenotypes among black patients, but HER2 status did not differ by race. Patients with lobular cancer were less likely to have TN breast cancer compared with patients with ductal tumors (odds ratio [OR] = 0.23; 95% confidence interval [CI], 0.10-0.58). Among patients with regional disease, black patients exhibited increased risk of death (relative risk [RR] = 2.71; 95% CI, 1.48-4.97) independent of TN status. No survival disparity was found among patients with local disease.
These registry-based data corroborate reports that TN breast cancer varies substantially by race and histologic subtype. A survival disparity among patients with advanced disease, but not local disease, casts some doubt on TN status as an explanation for differences.
More research is warranted to understand why black patients with advanced breast cancer may be at increased risk for death whether or not their tumors express the TN phenotype.
新的研究表明，黑人乳腺癌患者中三重阴性（TN）亚型（人表皮生长因子受体[HER]2(-)、雌激素受体ER和孕激素受体[PR])(-)）的患病率显著更高。然而，目前还没有从全州癌症登记处得到报告。
这项研究包括所有黑人患者（N=643）和白人患者的随机样本（n=719），他们被诊断患有原发性浸润性乳腺癌（2000-2003 年），列入国家癌症研究所-监测、流行病学和最终结果（NCI-SEER）康涅狄格肿瘤登记处（CTR）。HER2 状态从提交给登记处的病理报告中获得。其余数据从登记处数据库中获得。
与白人患者相比，黑人患者中 TN 肿瘤更为常见（分别为 30.8%和 11.2%；P<0.001）。黑人患者中 ER(-)和 PR(-)表型的频率增加了两倍，但 HER2 状态不因种族而异。与导管肿瘤患者相比，患有小叶癌的患者发生 TN 乳腺癌的可能性较小（比值比[OR] = 0.23；95%置信区间[CI]，0.10-0.58）。在局部疾病患者中，黑人患者的死亡风险增加（相对风险[RR] = 2.71；95%置信区间，1.48-4.97），与 TN 状态无关。在局部疾病患者中没有发现生存差异。
这些基于登记处的数据证实了报告，即 TN 乳腺癌在很大程度上因种族和组织学亚型而异。在晚期疾病患者中存在生存差异，但在局部疾病患者中没有，这对 TN 状态是否是导致差异的原因提出了一些质疑。
需要进一步研究以了解为什么黑人晚期乳腺癌患者的死亡风险增加，无论其肿瘤是否表达 TN 表型。
