Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
JAMA Oncol. 2021 Jul 1;7(7):1016-1023. doi: 10.1001/jamaoncol.2021.1254.
To our knowledge, there is no consensus regarding differences in treatment and mortality between non-Hispanic African American and non-Hispanic White women with triple-negative breast cancer (TNBC). Little is known about whether racial disparities vary by sociodemographic, clinical, and neighborhood factors.
To examine the differences in clinical treatment and outcomes between African American and White women in a nationally representative cohort of patients with TNBC and further examine the contributions of sociodemographic, clinical, and neighborhood factors to TNBC outcome disparities.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study included 23 123 women who received a diagnosis of nonmetastatic TNBC between January 1, 2010, and December 31, 2015, followed up through December 31, 2016, and identified from the Surveillance, Epidemiology, and End Results data set. The study was conducted from July 2019 to November 2020. The analyses were performed from July 2019 to June 2020.
Race and ethnicity, including non-Hispanic African American and non-Hispanic White race.
Using logistic regression analysis and competing risk regression analysis, we estimated odds ratios (ORs) of receipt of treatment and hazard ratios (HRs) of breast cancer mortality in African American patients compared with White patients.
Of 23 213 participants, 5881 (25.3%) were African American women and 17 332 (74.7%) were White women. Compared with White patients, African American patients had lower odds of receiving surgery (OR, 0.69; 95% CI, 0.60-0.79) and chemotherapy (OR, 0.89; 95% CI, 0.81-0.99) after adjustment for sociodemographic, clinicopathologic, and county-level factors. During a 43-month follow-up, 3276 patients (14.2%) died of breast cancer. The HR of breast cancer mortality was 1.28 (95% CI, 1.18-1.38) for African American individuals after adjustment for sociodemographic and county-level factors. Further adjustment for clinicopathological and treatment factors reduced the HR to 1.16 (95% CI, 1.06-1.25). This association was observed in patients living in socioeconomically less deprived counties (HR, 1.26; 95% CI, 1.14-1.39), urban patients (HR, 1.21; 95% CI, 1.11-1.32), patients having stage II (HR, 1.19; 95% CI, 1.02-1.39) or III (HR, 1.15; 95% CI, 1.01-1.31) tumors that were treated with chemotherapy, and patients younger than 65 years (HR, 1.24; 95% CI, 1.12-1.37).
In this retrospective cohort study, African American women with nonmetastatic TNBC had a significantly higher risk of breast cancer mortality compared with their White counterparts, which was partially explained by their disparities in receipt of surgery and chemotherapy.
重要提示：据我们所知，目前还没有关于非裔美国人和非裔白人女性在接受三阴性乳腺癌（TNBC）治疗和死亡率方面存在差异的共识。对于种族差异是否因社会人口学、临床和社区因素而有所不同，人们知之甚少。
目的：在全国代表性的 TNBC 患者队列中，检查非裔美国人和白人女性在临床治疗和结局方面的差异，并进一步研究社会人口学、临床和社区因素对 TNBC 结局差异的贡献。
设计、地点和参与者：本基于人群的回顾性队列研究纳入了 2010 年 1 月 1 日至 2015 年 12 月 31 日期间被诊断为非转移性 TNBC 的 23123 名女性，随访至 2016 年 12 月 31 日，并从监测、流行病学和最终结果数据集中确定。该研究于 2019 年 7 月至 2020 年 11 月进行。分析于 2019 年 7 月至 2020 年 6 月进行。
暴露因素：种族和民族，包括非裔美国人和非裔白人种族。
主要结局和测量：使用逻辑回归分析和竞争风险回归分析，我们估计了非裔美国患者与白种人患者接受治疗的比值比（OR）和乳腺癌死亡率的风险比（HR）。
结果：在 23213 名参与者中，5881 名（25.3%）为非裔美国女性，17332 名（74.7%）为白种人女性。与白人患者相比，调整社会人口统计学、临床病理和县级因素后，非裔美国患者接受手术（OR，0.69；95%置信区间，0.60-0.79）和化疗（OR，0.89；95%置信区间，0.81-0.99）的可能性较低。在 43 个月的随访中，3276 名患者（14.2%）死于乳腺癌。调整社会人口统计学和县级因素后，非裔美国人的乳腺癌死亡率 HR 为 1.28（95%置信区间，1.18-1.38）。进一步调整临床病理和治疗因素将 HR 降低至 1.16（95%置信区间，1.06-1.25）。在生活在社会经济较不贫困县的患者中观察到这种关联（HR，1.26；95%置信区间，1.14-1.39）、城市患者（HR，1.21；95%置信区间，1.11-1.32）、接受 II 期（HR，1.19；95%置信区间，1.02-1.39）或 III 期（HR，1.15；95%置信区间，1.01-1.31）肿瘤且接受化疗的患者，以及年龄小于 65 岁的患者（HR，1.24；95%置信区间，1.12-1.37）。
结论：在这项回顾性队列研究中，非转移性 TNBC 的非裔美国女性与白人女性相比，乳腺癌死亡的风险显著增加，这部分是由于她们在接受手术和化疗方面的差异所致。
