Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Clin Exp Metastasis. 2018 Oct;35(7):613-623. doi: 10.1007/s10585-018-9932-8. Epub 2018 Aug 22.
Black race compared to white race is associated with more advanced stage and biologically aggressive breast cancer. Consequently, black patients are more frequently treated with neoadjuvant chemotherapy (NAC) than white patients. However, it is unclear how distant recurrence-free survival (DRFS) of black patients treated with NAC, compares to DRFS of black patients treated with adjuvant chemotherapy (AC). We evaluated the association between race, distant recurrence, and type of chemotherapy (AC or NAC) in localized or locally advanced breast cancer. We evaluated DRFS in 807 patients, including 473 black, 252 white, 56 Hispanic, and 26 women of other or mixed race. The association between AC or NAC and DRFS was examined using multivariate Cox proportional hazard models that included race, age, stage, estrogen receptor (ER) and triple negative (TN) status. When the black and white subjects were pooled for the analysis the features associated with worse DRFS included stage III disease and age < 50 years, but not ER-negative disease, TN disease, the use of NAC, or black race. However, in the analysis stratified by race NAC was associated with worse DRFS compared to AC in black (HR 2.70; 95% CI 1.73-4.22; p < 0.0001), but not in white women (HR 1.29, 95% CI 0.56-2.95; p = 0.36). Black patients treated with NAC had worse DRFS than black patients treated with AC, or white patients treated with either NAC or AC. These findings need to be validated in a large-scale observational study and the effect of NAC on the breast cancer microenvironment in black women needs to be further evaluated.
与白种人相比，黑种人患有更晚期且生物学侵袭性更强的乳腺癌。因此，黑种人比白种人更常接受新辅助化疗（NAC）治疗。然而，目前尚不清楚接受 NAC 治疗的黑种患者的无远处复发生存率（DRFS）与接受辅助化疗（AC）治疗的黑种患者的 DRFS 相比如何。我们评估了种族、远处复发与局部或局部晚期乳腺癌化疗类型（AC 或 NAC）之间的关系。我们评估了 807 例患者的 DRFS，其中包括 473 例黑种人、252 例白种人、56 例西班牙裔和 26 例其他或混合种族的女性。使用包括种族、年龄、分期、雌激素受体（ER）和三阴性（TN）状态的多变量 Cox 比例风险模型来评估 AC 或 NAC 与 DRFS 之间的关系。当将黑人和白人患者合并进行分析时，与较差的 DRFS 相关的特征包括 III 期疾病和年龄<50 岁，但与 ER 阴性疾病、TN 疾病、使用 NAC 或黑种人无关。然而，在按种族分层的分析中，与 AC 相比，NAC 与黑种人（HR 2.70；95%CI 1.73-4.22；p<0.0001）的较差 DRFS 相关，但与白人女性（HR 1.29；95%CI 0.56-2.95；p=0.36）无关。与接受 AC 治疗的黑种人相比，接受 NAC 治疗的黑种患者的 DRFS 更差，与接受 NAC 或 AC 治疗的白种患者相比也是如此。这些发现需要在大规模观察性研究中得到验证，并且需要进一步评估 NAC 对黑种女性乳腺癌微环境的影响。
