310 Cedar St, LH 118, Yale University School of Medicine, Department of Surgery, New Haven, CT 06510, USA.
Icahn School of Medicine at Mt. Sinai, Department of Internal Medicine, New York, NY 10029, USA.
Am J Surg. 2019 Oct;218(4):689-694. doi: 10.1016/j.amjsurg.2019.07.012. Epub 2019 Jul 18.
Although breast cancer incidence is higher among white women, black women are more likely to have aggressive tumors with less favorable histology, and to have a worse prognosis. Obesity and alcohol consumption have been identified as two modifiable risk factors for breast cancer, while physical activity may offer protection. Little however is known about the association of these factors with race on the severity of breast cancer.
Data collected as part of a large prospective study looking at insulin resistance and race among women with breast cancer was queried for patient characteristics, lifestyle factors and tumor characteristics. The association with Nottingham Prognostic Index (NPI) was assessed with different models using univariate and multivariate linear regression.
Among 746 women in our cohort, 82% (n = 615) were white and 18% (n = 131) were black, mean age 58 years. Black patients were more likely to have high BMI (31.0 vs. 26.7, p < 0.0001), comorbidities (69% vs 55%, p = 0.01), self-reported poor diet (70% vs 42%, p < 0.001), be sedentary (56% vs 46%, p = 0.03) and were less likely to consume alcohol (8% vs 32%, p < 0.0001) compared to white patients. Overall, 137 (18%) of the patients had poorer prognosis (NPI > 4.4), which was significantly associated with younger age (55.6 vs 58.5 years, p = 0.02), black race (27% vs 15%, p = 0.001), triple negative cancer (15% vs 6%, p = 0.003), and poor diet (54% vs 45%, p = 0.046) compared to patients with better prognosis (NPI ≤ 4.4). On multivariate analysis, (model R = 0.12; p < 0.001), age (β = -0.011 per year, p = 0.002), healthy diet (β = -0.195, p = 0.02), and exercise (β = -0.004, p = 0.02) were associated with better prognosis, while black race (β = 0.247, p = 0.02) and triple negative cancer (β = 0.908, p < 0.0001) were associated with poor prognosis. Neither alcohol use nor BMI was significantly associated with NPI.
Among modifiable risk factors, diet and exercise are associated with NPI. Unmodifiable factors including race and biologic subtype remain the most important determinants of prognosis.
尽管乳腺癌在白人女性中的发病率较高，但黑人女性更有可能患有组织学较差、侵袭性更强的肿瘤，且预后更差。肥胖和饮酒已被确定为两种可改变的乳腺癌风险因素，而身体活动可能提供保护。然而，关于这些因素与种族对乳腺癌严重程度的影响知之甚少。
本研究的数据来自一项大型前瞻性研究，旨在研究乳腺癌女性中的胰岛素抵抗和种族，该研究查询了患者特征、生活方式因素和肿瘤特征。使用单变量和多变量线性回归评估与诺丁汉预后指数（NPI）的关联。
在我们的队列中，746 名女性中 82%（n=615）为白人，18%（n=131）为黑人，平均年龄为 58 岁。黑人患者更有可能 BMI 较高（31.0 与 26.7，p<0.0001）、合并症更多（69%与 55%，p=0.01）、自我报告饮食较差（70%与 42%，p<0.001）、久坐不动（56%与 46%，p=0.03）且饮酒较少（8%与 32%，p<0.0001）。总体而言，137 名（18%）患者预后较差（NPI>4.4），与年龄较轻（55.6 与 58.5 岁，p=0.02）、黑种人（27%与 15%，p=0.001）、三阴性癌症（15%与 6%，p=0.003）和不良饮食（54%与 45%，p=0.046）显著相关。与预后较好的患者（NPI≤4.4）相比，在多变量分析中（模型 R=0.12；p<0.001），年龄（每年减少 0.011，p=0.002）、健康饮食（β=-0.195，p=0.02）和运动（β=-0.004，p=0.02）与更好的预后相关，而黑种人（β=0.247，p=0.02）和三阴性癌症（β=0.908，p<0.0001）与较差的预后相关。饮酒和 BMI 与 NPI 均无显著相关性。
在可改变的危险因素中，饮食和运动与 NPI 相关。不可改变的因素，包括种族和生物学亚型，仍然是预后的最重要决定因素。
