Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, Penn.
Clinical Breast Care Project, Murtha Cancer Center, Bethesda, Md.
Ethn Dis. 2016 Jul 21;26(3):407-16. doi: 10.18865/ed.26.3.407.
Breast cancer mortality rates are higher for African American women (AAW) than for any other ethnic group in the United States. Recent reports suggest that outcome disparities between AAW and European American women (EAW) are present in the ER+HER2- subtype. To improve our understanding, pathological characteristics, mortality and molecular profiles from women treated within an equal-access health care system were evaluated.
All AAW (n=90) and EAW (n=308) with ER+HER2- tumors were identified. Gene expression profiles were generated from primary breast tumors from 57 AAW and 181 EAW. Pathological characteristics, survival and gene expression analysis were evaluated using chi-square analysis, log-rank tests and ANOVA.
Tumors from AAW were significantly more likely to be PR-, Ki67+ and of higher grade. Tumor stage, size and lymph node status did not differ significantly, nor did mortality rates (P=.879). At the molecular level, genes PSPHL and CRYBB2P1 were expressed at significantly higher levels in tumor tissues as well as normal stroma and blood from AAW. Polymorphisms controlling expression of each gene were identified with minor allele frequencies differing significantly between populations but not between cases and controls within each population.
Survival disparities were not detected in patients with ER+HER2- tumors treated within an equal-access health care system and molecular differences in tumors were not causal. Thus, outcome disparities in AAW with ER+HER2- tumors are largely attributable to socioeconomic factors affecting access to screening and treatment, rather than reflecting underlying biological differences.
美国非裔美国女性（AAW）的乳腺癌死亡率高于任何其他族裔群体。最近的报告表明，AAW 和欧洲裔美国女性（EAW）之间的结局差异存在于 ER+HER2- 亚型中。为了更好地理解这一点，评估了在平等获得医疗保健系统内接受治疗的女性的病理特征、死亡率和分子谱。
确定了所有 ER+HER2- 肿瘤的 AAW（n=90）和 EAW（n=308）。从 57 名 AAW 和 181 名 EAW 的原发性乳腺癌肿瘤中生成基因表达谱。使用卡方分析、对数秩检验和 ANOVA 评估病理特征、生存和基因表达分析。
AAW 的肿瘤更有可能是 PR-、Ki67+和更高的分级。肿瘤分期、大小和淋巴结状态没有显著差异，死亡率也没有显著差异（P=.879）。在分子水平上，PSPHL 和 CRYBB2P1 基因在 AAW 的肿瘤组织以及正常基质和血液中的表达水平显著更高。控制每个基因表达的多态性与人群之间的小等位基因频率有显著差异，但在每个人群中的病例和对照之间没有差异。
在平等获得医疗保健系统内接受治疗的 ER+HER2- 肿瘤患者中未发现生存差异，肿瘤中的分子差异不是因果关系。因此，ER+HER2- 肿瘤的 AAW 之间的结局差异主要归因于影响筛查和治疗机会的社会经济因素，而不是反映潜在的生物学差异。
