Gomez Alexandra, DeGennaro Vincent, George Sophia H L, Reis Isildinha M, Santamaria Estefania, Westin Gustavo Figueiredo, Gabriel Dieudina, Hurley Judith
, , and , University of Miami/Jackson Memorial Hospital; , Sylvester Comprehensive Cancer Center, University of Miami; , Sylvester Biostatistics and Bioinformatics Core Resource, University of Miami, Miami; and , University of Florida College of Medicine, Gainesville, FL; and and , Innovating Health International, Port-au-Prince, Haiti.
J Glob Oncol. 2016 Nov 2;3(4):389-399. doi: 10.1200/JGO.2016.005975. eCollection 2017 Aug.
We compared a cohort of Haitian immigrants with residents in Haiti with breast cancer (BC) to evaluate the effects of location on presentation, treatment, and outcomes.
Participants were Haitian women with BC living in Miami who presented to the University of Miami/Jackson Memorial Hospital and women with BC living in Haiti who presented to the Innovating Health International Women's Cancer Center. The primary outcome was the relationship between location, cancer characteristics, and survival. The secondary objective was to compare our results with data extracted from the SEER database. Cox regression was used to compare survival.
One hundred two patients from University of Miami/Jackson Memorial Hospital and 94 patients from Innovating Health International were included. The patients in Haiti, compared with the patients in Miami, were younger (mean age, 50.2 53.7 years, respectively; = .042), presented after a longer duration of symptoms (median, 20 3 months, respectively; < .001), had more advanced stage (44.7% 25.5% with stage III and 27.6% 18.6% with stage IV BC, respectively), and had more estrogen receptor (ER) -negative tumors (44.9% 26.5%, respectively; = .024). The percentage of women who died was 31.9% in Haiti died compared with 17.6% in Miami. Median survival time was 53.7 months for women in Haiti and was not reached in Miami. The risk of death was higher for women in Haiti versus women in Miami (adjusted hazard ratio, 3.09; = .0024).
Women with BC in Haiti experience a significantly worse outcome than immigrants in Miami, which seems to be related to a more advanced stage and younger age at diagnosis, more ER-negative tumors, and lack of timely effective treatments. The differences in age and ER status are not a result of access to care and are unexplained.
我们将一组海地移民乳腺癌（BC）患者与海地本土乳腺癌患者进行比较，以评估地域对疾病表现、治疗及预后的影响。
参与者为居住在迈阿密且前往迈阿密大学/杰克逊纪念医院就诊的海地乳腺癌女性患者，以及居住在海地且前往国际创新健康女性癌症中心就诊的乳腺癌女性患者。主要结局是地域、癌症特征与生存之间的关系。次要目标是将我们的结果与从监测、流行病学和最终结果（SEER）数据库提取的数据进行比较。采用Cox回归比较生存率。
纳入了来自迈阿密大学/杰克逊纪念医院的102例患者和来自国际创新健康的94例患者。与迈阿密的患者相比，海地的患者更年轻（平均年龄分别为50.2岁和53.7岁；P = 0.042），症状持续时间更长（中位数分别为20个月和3个月；P < 0.001），疾病分期更晚（III期分别为44.7%和25.5%，IV期乳腺癌分别为27.6%和18.6%），雌激素受体（ER）阴性肿瘤更多（分别为44.9%和26.5%；P = 0.024）。海地死亡女性的比例为31.9%，而迈阿密为17.6%。海地女性的中位生存时间为53.7个月，迈阿密的未达到。海地女性的死亡风险高于迈阿密女性（调整后的风险比为3.09；P = 0.0024）。
海地的乳腺癌女性患者的预后明显比迈阿密的移民患者差，这似乎与诊断时疾病分期更晚、年龄更小、ER阴性肿瘤更多以及缺乏及时有效的治疗有关。年龄和ER状态的差异并非获得医疗服务的结果，且原因不明。
