Bilani Nadeem, Zabor Emily C, Elson Leah, Elimimian Elizabeth B, Nahleh Zeina
Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, USA.
Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, USA.
J Cancer Epidemiol. 2020 Oct 30;2020:6387378. doi: 10.1155/2020/6387378. eCollection 2020.
Breast cancer remains the most commonly diagnosed malignancy in women. It encompasses considerable heterogeneity in pathology, patient clinical characteristics, and outcome. This study describes factors associated with overall survival (OS) of breast cancer in an updated national database.
We conducted a retrospective analysis of patients with breast cancer diagnosed between 2004 and 2016 based on the National Cancer Database. Categorical variables were summarized using frequencies/percentages, whereas continuous variables were summarized using the median/interquartile range (IQR). OS was explored using the Kaplan-Meier method.
Data from = 2,671,549 patients were analyzed. The median age at diagnosis was 61 years (range 18-90). 75% were non-Hispanic (NH) White; 11% were NH-Black; 4.7% were Hispanic-White; 0.1% were Hispanic-Black; and 3.4% were Asian. Most cases (73%) presented with ductal carcinoma histology; while 15% with lobular carcinoma. Rarer subtypes included epithelial-myoepithelial, fibroepithelial, metaplastic, and mesenchymal tumors. OS was associated with molecular subtype, histologic subtype, and AJCC clinical staging. Survival also correlated with race: a cohort including Asians and Pacific Islanders had the best survival, while Black patients had the worst. Finally, facility type also impacted outcome: patients at academic centers had the best survival, while those at community cancer programs had the worst.
This large database provides a recent and comprehensive overview of breast cancer over 12 years. Molecular subtype, histologic subtype, stage, race, and facility type were correlated with OS. In addition to the educational perspective of this overview, significant factors impacting the outcome identified here should be considered in future cancer research on disparities.
乳腺癌仍然是女性中最常被诊断出的恶性肿瘤。它在病理学、患者临床特征和预后方面存在相当大的异质性。本研究在一个更新的国家数据库中描述了与乳腺癌总生存期（OS）相关的因素。
我们基于国家癌症数据库对2004年至2016年间诊断出的乳腺癌患者进行了回顾性分析。分类变量使用频率/百分比进行汇总，而连续变量使用中位数/四分位间距（IQR）进行汇总。使用Kaplan-Meier方法探索总生存期。
分析了来自2,671,549名患者的数据。诊断时的中位年龄为61岁（范围18 - 90岁）。75%为非西班牙裔（NH）白人；11%为NH黑人；4.7%为西班牙裔白人；0.1%为西班牙裔黑人；3.4%为亚洲人。大多数病例（73%）组织学类型为导管癌；而15%为小叶癌。较罕见的亚型包括上皮-肌上皮、纤维上皮、化生和间叶性肿瘤。总生存期与分子亚型、组织学亚型和美国癌症联合委员会（AJCC）临床分期相关。生存率也与种族相关：包括亚洲人和太平洋岛民的队列生存率最佳，而黑人患者生存率最差。最后，机构类型也影响预后：学术中心的患者生存率最佳，而社区癌症项目的患者生存率最差。
这个大型数据库提供了12年来乳腺癌的最新全面概述。分子亚型、组织学亚型、分期、种族和机构类型与总生存期相关。除了本概述的教育意义外，未来癌症差异研究应考虑在此确定的影响预后的重要因素。
