Monzavi-Karbassi Behjatolah, Siegel Eric R, Medarametla Srikanth, Makhoul Issam, Kieber-Emmons Thomas
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Division of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Oncol Lett. 2016 Aug;12(2):1337-1342. doi: 10.3892/ol.2016.4804. Epub 2016 Jun 29.
Despite progress in breast cancer treatment, disparity persists in survival time between African American (AA) and Caucasian women in the US. Tumor stage and tumor grade are the major prognostic factors that define tumor aggressiveness and contribute to racial disparity between AA and Caucasian women. Studying the interaction of race with tumor grade or stage may provide further insights into the role of intrinsic biological aggressiveness in disecting the AA-Caucasian survival disparity. Therefore, the current study was performed to evaluate the interaction of race with tumor grade and stage at diagnosis regarding survival in a cohort of patients treated at the Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences (Little Rock, AR, USA). The cohort included 1,077 patients, 208 (19.3%) AA and 869 (80.7%) Caucasian, diagnosed with breast cancer between January 1997 and December 2005. Kaplan-Meier survival plots were generated and Cox regressions were performed to analyze the associations of race with breast cancer-specific survival time. Over a mean follow-up time of 1.5 years, AA women displayed increased mortality risk due to breast cancer-specific causes [hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.23-2.46]. The magnitude of racial disparity varied strongly with tumor grade (race-x-grade interaction; P<0.001). No significant interaction was observed between race and tumor stage or race and age at diagnosis. Among women diagnosed with grade I tumors, the race disparity in survival time after controlling for tumor stage and age was strong (HR, 9.07; 95% CI, 2.11-38.95), but no significant AA-Caucasian disparity was observed among women with higher-grade tumors. The data suggest that, when diagnosed with grade I breast cancer, AA may experience poorer survival outcomes compared with Caucasian patients, regardless of tumor stage or age. The findings potentially provide significant clinical and public health implications and justify further investigation.
尽管乳腺癌治疗取得了进展，但美国非裔美国女性（AA）和白人女性在生存时间上的差异依然存在。肿瘤分期和肿瘤分级是定义肿瘤侵袭性并导致AA和白人女性种族差异的主要预后因素。研究种族与肿瘤分级或分期的相互作用，可能会进一步深入了解内在生物学侵袭性在剖析AA与白人之间生存差异中的作用。因此，本研究旨在评估在美国阿肯色大学医学科学温思罗普·P·洛克菲勒癌症研究所（美国阿肯色州小石城）接受治疗的一组患者中，种族与诊断时肿瘤分级和分期在生存方面的相互作用。该队列包括1077例患者，其中208例（19.3%）为AA患者，869例（80.7%）为白人患者，于1997年1月至2005年12月期间被诊断为乳腺癌。生成了Kaplan-Meier生存曲线，并进行了Cox回归分析，以分析种族与乳腺癌特异性生存时间的关联。在平均1.5年的随访时间里，AA女性因乳腺癌特异性原因导致的死亡风险增加[风险比（HR），1.74；95%置信区间（CI），1.23 - 2.46]。种族差异的程度随肿瘤分级有很大变化（种族 - 分级相互作用；P < 0.001）。在种族与肿瘤分期或种族与诊断时年龄之间未观察到显著的相互作用。在诊断为I级肿瘤的女性中，在控制肿瘤分期和年龄后，生存时间的种族差异很大（HR，9.07；95% CI，2.11 - 38.95），但在高级别肿瘤女性中未观察到显著的AA与白人之间的差异。数据表明，当被诊断为I级乳腺癌时，无论肿瘤分期或年龄如何，AA患者与白人患者相比可能经历更差的生存结果。这些发现可能具有重要的临床和公共卫生意义，并为进一步研究提供了依据。
