Camacho-Rivera Marlene, Kalwar Tricia, Sanmugarajah Jasotha, Shapira Iuliana, Taioli Emanuela
Department of Population Health, Hofstra North Shore-LIJ School of Medicine and The Feinstein Institute for Medical Research, Great Neck, New York.
Breast J. 2014 Sep-Oct;20(5):489-95. doi: 10.1111/tbj.12302. Epub 2014 Jul 8.
Breast cancer mortality in black women is disproportionately high; reasons for this phenomenon are still unclear. In addition to socioeconomic factors, the biology of the tumor may play a role. We analyzed 1,097 incident invasive breast cancer cases diagnosed between 2000 and 2010 in black US women from Long Island and Brooklyn. Thirty-five percent of women had an estrogen receptor (ER) negative tumor, 46% a progesterone receptor (PR) negative tumor. ER, PR negative tumors were diagnosed at an earlier age (55.8 versus 55.3 years), at a later stage (p = 0.06), were larger in size (p = 0.04), and more frequently treated with neo-adjuvant chemotherapy (p = 0.06) than ER, PR positive tumors. Determinants of shorter survival were: ER, PR negativity (HR: 2.2, 95% CI: 1.4-3.4), age, and stage at diagnosis (HR: 2.0; 95% CI: 1.5-2.7). ER, PR negative breast cancer born outside of the US experienced a significantly worse survival than ER, PR negative women who were born in the US. ER, PR negative tumors in black women born outside the US, mainly in the Caribbean, are biologically more aggressive than the same size and age-matched tumors in black women born in the US. Our study suggests that environmental exposures in the country of origin may impact on host cancer interactions and cancer outcome.
黑人女性的乳腺癌死亡率高得不成比例；这一现象的原因仍不清楚。除社会经济因素外，肿瘤生物学可能也起了作用。我们分析了2000年至2010年间在长岛和布鲁克林诊断出的1097例美国黑人女性浸润性乳腺癌新发病例。35%的女性患有雌激素受体（ER）阴性肿瘤，46%患有孕激素受体（PR）阴性肿瘤。与ER、PR阳性肿瘤相比，ER、PR阴性肿瘤的诊断年龄更早（55.8岁对55.3岁），诊断分期更晚（p = 0.06），肿瘤更大（p = 0.04），接受新辅助化疗的频率更高（p = 0.06）。生存时间较短的决定因素为：ER、PR阴性（风险比：2.2，95%置信区间：1.4 - 3.4）、年龄以及诊断时的分期（风险比：2.0；95%置信区间：1.5 - 2.7）。在美国境外出生的ER、PR阴性乳腺癌患者的生存率明显低于在美国出生的ER、PR阴性女性。在美国境外出生的黑人女性（主要在加勒比地区）的ER、PR阴性肿瘤在生物学上比在美国出生的同年龄、同大小的黑人女性肿瘤更具侵袭性。我们的研究表明，原籍国的环境暴露可能会影响宿主与癌症的相互作用以及癌症的预后。
