三模态治疗中雌激素受体阳性乳腺癌患者的种族差异。

Racial disparity in estrogen receptor positive breast cancer patients receiving trimodality therapy.

机构信息

Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

出版信息

Breast. 2012 Jun;21(3):276-83. doi: 10.1016/j.breast.2011.11.003. Epub 2011 Dec 16.

DOI:10.1016/j.breast.2011.11.003

PMID:22178596

Abstract

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

简介

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。

方法

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。

结果

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）。