Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Breast. 2012 Jun;21(3):276-83. doi: 10.1016/j.breast.2011.11.003. Epub 2011 Dec 16.
We assessed racial differences in progression-free survival (PFS) and overall survival (OS) in relation to subtype in uniformly treated stage II-III breast cancer patients.
We reviewed records of 582 patients receiving post-mastectomy radiation (PMRT) between 1/1999 and 12/2009 and evaluated the effect of demographic, tumor, and treatment characteristics on PFS and OS.
Median follow up was 44.7 months. 24% of patients were black and 76% white. All had mastectomy and PMRT; 98% had chemotherapy; Estrogen receptor (ER)+ patients received endocrine therapy. Black patients were more likely to have ER- (56% vs. 38%, p=0.0001), progesterone receptor (PR)- (69% vs. 54%, p = 0.002), and triple negative (TN) (46% vs. 24%, p < 0.0001) tumors. Overall, black patients had worse PFS (60.6% vs. 78.3%, p = 0.001) and OS (72.8% vs. 87.7%, p < 0.0001). There was no racial difference in PFS (p = 0.229 and 0.273 respectively) or OS (p = 0.113 and 0.097 respectively) among ER- or TN. Among ER+, black patients had worse PFS (55% vs. 81%, p < 0.001) and OS (73% vs. 91%, p < 0.0001). The difference in PFS was seen in the ER+/PR+/HER2- subgroup (p = 0.002) but not ER+/PR-/HER2- (p = 0.129), and in the post-menopausal ER+/HER2- subgroup (p = 0.004) but not pre/peri-menopausal ER+/HER2- (p = 0.150).
Black women had worse survival outcomes in this cohort. This disparity was driven by (1) a higher proportion of ER- and TN tumors in black women and (2) worse outcome of similarly treated black women with ER+ breast cancer. The underlying causes of racial disparity within hormone receptor categories must be further examined.
我们评估了在接受统一治疗的 II 期至 III 期乳腺癌患者中，与亚型相关的无进展生存期（PFS）和总生存期（OS）的种族差异。
我们回顾了 582 例接受乳房切除术（PMRT）后于 1999 年 1 月至 2009 年 12 月接受治疗的患者的记录，并评估了人口统计学、肿瘤和治疗特征对 PFS 和 OS 的影响。
中位随访时间为 44.7 个月。24%的患者为黑人，76%为白人。所有患者均接受乳房切除术和 PMRT；98%接受化疗；雌激素受体（ER）阳性患者接受内分泌治疗。黑人患者 ER-（56% vs. 38%，p=0.0001）、孕激素受体（PR）-（69% vs. 54%，p = 0.002）和三阴性（TN）（46% vs. 24%，p < 0.0001）肿瘤的比例更高。总体而言，黑人患者的 PFS（60.6% vs. 78.3%，p = 0.001）和 OS（72.8% vs. 87.7%，p < 0.0001）更差。ER-或 TN 患者之间在 PFS（p = 0.229 和 0.273）或 OS（p = 0.113 和 0.097）方面无种族差异。在 ER+患者中，黑人患者的 PFS（55% vs. 81%，p < 0.001）和 OS（73% vs. 91%，p < 0.0001）更差。在 ER+/PR+/HER2-亚组中观察到 PFS 差异（p = 0.002），但在 ER+/PR-/HER2-亚组中未观察到（p = 0.129），在绝经后 ER+/HER2-亚组中观察到（p = 0.004），但在绝经前/围绝经期 ER+/HER2-亚组中未观察到（p = 0.150）。
在本队列中，黑人女性的生存结局更差。这种差异是由（1）黑人女性中 ER-和 TN 肿瘤比例较高，以及（2）接受相似治疗的黑人女性中 ER+乳腺癌的结局更差所致。必须进一步研究激素受体类别内种族差异的根本原因。
