亚裔美国人和太平洋岛民女性 0 期-Ⅱ期乳腺癌的细分揭示了生存和手术-放疗间隔方面的差异：2004 年至 2017 年国家癌症数据库分析。
Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017.
机构信息
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA.
Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY.
出版信息
JCO Oncol Pract. 2022 Aug;18(8):e1255-e1264. doi: 10.1200/OP.22.00001. Epub 2022 May 20.
PURPOSE
Aggregation of Asian Americans (AAs) with Native Hawaiians and Other Pacific Islanders (NHPIs) masks significant health disparities. We evaluated overall survival (OS) and surgery-to-radiation intervals (STRIs) among AA and NHPI women with early-stage breast cancer.
METHODS
This National Cancer Database study included women with stage 0-II breast cancer diagnosed between 2004 and 2017. STRI was defined as days from surgery to radiation. Patients were stratified by adjuvant treatment. AAs were disaggregated into geographically relevant subpopulations: East, South, and Southeast Asians. Kaplan-Meier estimates and log-rank tests assessed survival. Cox proportional hazard and linear regression were adjusted for clinical and sociodemographic factors.
RESULTS
In total, 578,927 women were included (median age 61 years, median follow-up 65 months, and 10-year OS 83%). AA and NHPI 10-year OS was 91% overall; subpopulation 10-year OS was 92% for East Asian, 90% for South Asian, 90% for Southeast Asian, and 83% for NHPI. On multivariable analysis, compared with non-Hispanic White, NHPI women had worse survival (adjusted hazard ratio [aHR] = 1.38; 95% CI, 1.09 to 1.77); all AA subpopulations had improved survival: East Asian (aHR = 0.57; 95% CI, 0.48 to 0.69), South Asian (aHR = 0.66; 95% CI, 0.51 to 0.84), and Southeast Asian (aHR = 0.78; 95% CI, 0.65 to 0.94). The AA and NHPI median STRI for was 73 days overall; the disaggregated median STRI was 68 days for East Asian, 80 days for South Asian, 77 days for Southeast Asians, and 81 days for NHPI. On adjusted analysis, compared with non-Hispanic White, Southeast Asians and NHPI had longer STRI by 6.6 (95% CI, 4.3 to 8.9) and 10.0 (95% CI, 5.8 to 14) days, respectively.
CONCLUSION
Breast cancer disparities exist among disaggregated AA and NHPI subpopulations. Data disaggregation insights may lead to interventions to overcome these disparities, such as optimizing time-to-treatment for select populations.
目的
将亚裔美国人（AA）与美属原住民和其他太平洋岛民（NHPIs）合并，掩盖了重大的健康差异。我们评估了早期乳腺癌 AA 和 NHPI 女性的总生存率（OS）和手术与放疗间隔（STRIs）。
方法
本项国家癌症数据库研究纳入了 2004 年至 2017 年间诊断为 0 期-II 期乳腺癌的女性。STRIs 定义为从手术到放疗的天数。根据辅助治疗对患者进行分层。AA 被分为地理相关的亚群：东亚、南亚和东南亚。Kaplan-Meier 估计和对数秩检验评估生存情况。Cox 比例风险和线性回归调整了临床和社会人口统计学因素。
结果
共有 578927 名女性入组（中位年龄 61 岁，中位随访时间 65 个月，10 年 OS 为 83%）。AA 和 NHPI 的 10 年 OS 总体为 91%；亚群 10 年 OS 东亚为 92%，南亚为 90%，东南亚为 90%，NHPI 为 83%。多变量分析显示，与非西班牙裔白人相比，NHPI 女性的生存率较差（调整后的危险比 [aHR] = 1.38；95%CI，1.09 至 1.77）；所有 AA 亚群的生存率均有所提高：东亚（aHR = 0.57；95%CI，0.48 至 0.69），南亚（aHR = 0.66；95%CI，0.51 至 0.84），东南亚（aHR = 0.78；95%CI，0.65 至 0.94）。AA 和 NHPI 的平均 STRI 中位数为 73 天；细分后的中位数 STRI 东亚为 68 天，南亚为 80 天，东南亚为 77 天，NHPI 为 81 天。在调整后的分析中，与非西班牙裔白人相比，东南亚人和 NHPI 的 STRI 分别延长了 6.6（95%CI，4.3 至 8.9）和 10.0（95%CI，5.8 至 14）天。
结论
在亚裔和 NHPI 亚群中存在乳腺癌差异。数据细分的见解可能会导致干预措施来克服这些差异，例如为特定人群优化治疗时间。
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