威尔罗杰斯现象、乳腺癌与种族。
The Will Rogers phenomenon, breast cancer and race.
机构信息
Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA.
Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
出版信息
BMC Cancer. 2021 May 17;21(1):554. doi: 10.1186/s12885-021-08125-8.
BACKGROUND
The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients' group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP.
METHODS
This is a retrospective analysis of 300 BC women (2007-2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes.
RESULTS
Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004).
CONCLUSION
The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.
背景
威尔罗杰斯现象（WRP）描述了由于肿瘤分级重新分类，患者组的结果明显改善。癌症分期对于选择适当的治疗方法和估计预后非常重要。WRP 已被描述为限制使用历史队列比较生存或治疗时最重要的偏倚之一。本研究的主要目的是评估在乳腺癌（BC）分期中从 AJCC 第 7 版到 AJCC 第 8 版的转移是否存在 WRP，以及种族差异是否在 WRP 的表达中表现出来。
方法
这是对一个学术医疗中心的 300 名 BC 女性（2007-2017 年）进行的回顾性分析。通过 Kaplan-Meier 分析估计总生存（OS）和无病生存（DFS）。使用双变量和多变量 Cox 回归分析来确定与结果相关的种族因素。
结果
我们的患者队列包括 30.3%的白种人（白人）和 69.7%的非裔美国人（黑人）。在解剖分期中，白人分别为 46.2%、26.3%、23.1%和 4.4%；黑人分别为 28.7%、43.1%、24.4%和 3.8%（p=0.043）。在预后分期中，白人分别为 52.8%、18.7%、23%和 5.5%，黑人分别为 35%、17.2%、43.5%和 4.3%（p=0.011）。共有白人（45.05%对 47.85%）黑人，升级。白人（16.49%对 14.35%）黑人，降级。其余 38.46%和 37.79%的患者分期不变。中位随访 54 个月后，黑人患者使用第 8 版比第 7 版显示出更好的 5 年 OS 分期率（p=0.000）。在白人中，那些在第 7 版中为 IIIA 期但在第 8 版中为 IB 期的患者预后优于第 8 版的 IIA 期和 IIB 期（p=0.000）。与使用第 7 版估计的 DFS 相比，第 8 版显示出复杂的结果（p=0.176）（p=0.004）。
结论
WRP 在从 AJCC 第 7 版到 BC 分期的第 8 版转移中存在显著的可变性（白人和黑人患者）。我们建议，在比较分期系统的结果时，需要谨慎，以在数据解释中考虑 WRP。
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