Wieder Robert, Shafiq Basit, Adam Nabil
Department of Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences.
The Cancer Institute of New Jersey, Rutgers Biomedical and Health Sciences.
J Cancer. 2020 Feb 21;11(10):2808-2820. doi: 10.7150/jca.39091. eCollection 2020.
African American women have not benefited equally from recently improved breast cancer survival. We investigated if this was true for all subsets. We identified 395,170 patients with breast adenocarcinoma from the SEER database from 1990 to 2011 with designated race, age, stage, grade, ER and PR status, marital status and laterality, as control. We grouped patients into two time periods, 1990-2000 and 2001-2011, three age categories, under 40, 40-69 and ≥ 70 years and two stage categories, I-III and IV. We used the Kaplan-Meier and logrank tests to compare survival curves. We stratified data by patient- and tumor-associated variables to determine co-variation among confounding factors using the Pearson Chi-square test and Cox proportional hazards regression to determine hazard ratios (HR) to compare survival. Stage I-III patients of both races ≥ 70 years old, African American widowed patients and Caucasians with ER- and PR- tumors had worse improvements in survival in 2001-2011 than younger, married or hormone receptor positive patients, respectively. In contrast, African Americans with ER- (Cox HR 0.70 [95% CI 0.65-0.76]) and PR- (Cox HR 0.67 [95% CI 0.62-0.72]) had greater improvement in survival in 2001-2011 than Caucasians with ER- (Cox HR 0.81 [95% CI 0.78-0.84]) and PR- disease (Cox HR 0.75 [95% CI 0.73-0.78]). This was not associated with changes in distribution of tumor or patient attributes. African American women with stage I-III ER- and PR- breast cancer had greater improvement in survival than Caucasians in 2001-2011. This is the first report of an improvement in racial disparities in survival from breast cancer in a subset of patients.
非裔美国女性并未从近期乳腺癌生存率的提高中平等受益。我们调查了所有亚组是否都是如此。我们从监测、流行病学和最终结果（SEER）数据库中确定了1990年至2011年期间395170例乳腺腺癌患者，这些患者具有指定的种族、年龄、分期、分级、雌激素受体（ER）和孕激素受体（PR）状态、婚姻状况及患侧情况，作为对照。我们将患者分为两个时间段，即1990 - 2000年和2001 - 2011年，三个年龄类别，40岁以下、40 - 69岁和70岁及以上，以及两个分期类别，I - III期和IV期。我们使用Kaplan - Meier法和对数秩检验来比较生存曲线。我们通过患者和肿瘤相关变量对数据进行分层，使用Pearson卡方检验来确定混杂因素之间的共变情况，并使用Cox比例风险回归来确定风险比（HR）以比较生存率。在2001 - 2011年，两个种族70岁及以上的I - III期患者、非裔美国寡妇患者以及患有ER和PR阴性肿瘤的白人患者，其生存率的改善情况分别比年轻、已婚或激素受体阳性患者更差。相比之下，在2001 - 2011年，患有ER阴性（Cox风险比0.70 [95%置信区间0.65 - 0.76]）和PR阴性（Cox风险比0.67 [95%置信区间0.62 - 0.72]）的非裔美国患者比患有ER阴性（Cox风险比0.81 [95%置信区间0.78 - 0.84]）和PR阴性疾病（Cox风险比0.75 [95%置信区间0.73 - 0.78]）的白人患者生存率改善更大。这与肿瘤或患者属性分布的变化无关。在2001 - 2011年，患有I - III期ER和PR阴性乳腺癌的非裔美国女性比白人女性生存率改善更大。这是关于一部分患者乳腺癌生存种族差异改善情况的首份报告。
