Engelking Marta, Marmor Schelomo, Burjak Mohamad, Hinojos Madeleine, Lloyd Whitney, Switalla Kayla M, Tuttle Todd M
Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA.
Center for Clinical Quality & Outcomes Discovery and Evaluation (C-QODE), Minneapolis, USA.
Breast Cancer Res Treat. 2023 Apr;198(2):187-195. doi: 10.1007/s10549-022-06826-7. Epub 2023 Jan 23.
American Indian/Alaska Native (AI/AN) women with estrogen receptor-positive (ER +) breast cancer have higher mortality compared to non-Hispanic whites (NHW). The purpose of this study is to compare rates of initiation of endocrine therapy (ET) between AI/AN and NHW and further determine survival outcomes for ER + breast cancer.
We used the National Cancer Database to identify patients diagnosed with ER + breast cancer, stage I-III, between 2004 and 2017. Multivariable logistic regression was performed to determine factors associated with initiation of adjuvant ET. Overall survival was estimated using the Kaplan-Meier analysis and Cox proportional hazards modeling.
We identified a total of 771,619 patients (AI/AN, n = 2473; NHW, n = 769,146). Compared to NHW, AI/AN patients were more likely to live in rural areas, be younger, and have tumors that were higher grade, node positive, and larger. Initiation of adjuvant ET was high in both groups and not significantly different between AI/AN and NHW. Independent predictors of ET initiation included rural location, age, higher tumor grade, node-positive disease, larger tumor size, and progesterone receptor-positive status. Initiation of ET was significantly associated with improved overall survival among all patients. Overall survival was significantly worse among the AI/AN population.
AI/AN race was significantly and independently associated with worse overall survival after diagnosis of ER + breast cancer. We did not find a significant difference in the initiation of adjuvant ET between AI/AN and NHW. Exact reasons why AI/AN women with ER + breast cancer have higher mortality rates remain elusive but are probably multifactorial.
雌激素受体阳性（ER +）乳腺癌的美国印第安/阿拉斯加原住民（AI/AN）女性的死亡率高于非西班牙裔白人（NHW）。本研究的目的是比较AI/AN和NHW之间内分泌治疗（ET）的起始率，并进一步确定ER +乳腺癌的生存结果。
我们使用国家癌症数据库来识别2004年至2017年间诊断为I-III期ER +乳腺癌的患者。进行多变量逻辑回归以确定与辅助ET起始相关的因素。使用Kaplan-Meier分析和Cox比例风险模型估计总生存期。
我们共识别出771,619名患者（AI/AN，n = 2473；NHW，n = 769,146）。与NHW相比，AI/AN患者更有可能居住在农村地区，更年轻，并且肿瘤分级更高、有淋巴结转移、更大。两组辅助ET的起始率都很高，AI/AN和NHW之间没有显著差异。ET起始的独立预测因素包括农村地区、年龄、更高的肿瘤分级、淋巴结阳性疾病、更大的肿瘤大小和孕激素受体阳性状态。ET起始与所有患者的总生存期改善显著相关。AI/AN人群的总生存期明显更差。
AI/AN种族与ER +乳腺癌诊断后的总生存期较差显著且独立相关。我们没有发现AI/AN和NHW之间辅助ET起始的显著差异。ER +乳腺癌的AI/AN女性死亡率较高的确切原因仍然难以捉摸，但可能是多因素的。
