Albert Einstein College of Medicine, Montefiore Medical Center-Weiler Division, 1825 Eastchester Rd, 2S-Rm 47, Bronx, NY 10461, USA.
J Natl Cancer Inst. 2012 Mar 7;104(5):406-14. doi: 10.1093/jnci/djr543. Epub 2012 Jan 16.
The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy.
The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline- and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided.
Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P < .001) and a higher body mass index (median: 31.7 vs 27.4 kg/m(2); P < .001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086).
Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.
之前的研究报告称，黑种人在可手术乳腺癌中的预后较差，这归因于更高的侵袭性三阴性疾病发病率、治疗差异和合并症。我们评估了黑种人在接受当代辅助治疗的患者中，按肿瘤激素受体和 HER2 表达情况与预后的相关性。
我们采用 Cox 比例风险模型，对接受含蒽环类和紫杉烷类化疗的临床试验人群进行了多项调整后，评估了黑种人对无病生存和总生存的影响。采用 Fisher 确切检验比较分类变量。所有 P 值均为双侧。
在 4817 例合格患者中，有 405 例（8.4%）为黑人。与非黑人患者相比，黑人患者的三阴性疾病发生率更高（31.9% vs. 17.2%；P<.001），体重指数更高（中位数：31.7 vs. 27.4 kg/m2；P<.001）。黑人种族与无病生存较差显著相关（5 年无病生存率，黑人 vs. 非黑人：76.7% vs. 84.5%；复发或死亡的风险比=1.58，95%置信区间=1.19 至 2.10，P=.0015）和总生存较差显著相关（5 年总生存率，黑人 vs. 非黑人：87.6% vs. 91.9%；死亡风险比=1.49，95%置信区间=1.05 至 2.12，P=.025），但在激素受体阳性 HER2 阴性疾病患者中与三阴性或 HER2 阳性疾病患者中无相关性。在一个包含黑人种族、激素受体阳性 HER2 阴性疾病与其他亚型以及它们相互作用的模型中，无病生存的交互项具有统计学意义（P=.027），但总生存的交互项无统计学意义（P=.086）。
除了治疗差异和侵袭性疾病之外，其他因素导致激素受体阳性乳腺癌黑人女性的复发率增加。
