Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA.
Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
J Surg Oncol. 2024 Jun;129(7):1179-1186. doi: 10.1002/jso.27625. Epub 2024 Apr 21.
Given persistent racial disparities in breast cancer outcomes, this study explores racial differences in disease-specific mortality and surgical management among patients with microinvasive ductal carcinoma in situ (DCIS-MI).
The Surveillance, Epidemiology, and End Results Program was queried for patients aged 18+ years with DCIS-MI between January 1, 2010 and December 31, 2018. The study cohort was divided into non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients. Disease-specific mortality was evaluated using Cox proportional hazards models.
A total of 3400 patients were identified, of which 569 (16.7%) were NHB and 2831 (83.3%) were NHW. Compared with NHW patients, NHB patients had more positive lymph nodes (7.6% vs. 3.9% p < 0.001). In addition, NHB women were more likely to undergo axillary lymph node dissection (6.0% vs. 3.8%, p = 0.044) and receive chemotherapy (11.8% vs. 7.2%, p < 0.001). There were no racial differences in breast surgery type (p = 0.168), reconstructive surgery (p = 0.362), or radiation therapy (p = 0.342). Overall, NHB patients had worse disease-specific mortality (adjusted hazard ratio 2.13, 95% confidence interval [CI]: 1.10-4.14) with mortality risks diverging from NHW women after 3 years (6 years rate ratio [RR] 2.12, 95% CI: 1.13-4.34; 9 years RR 2.32, 95% CI: 1.24-4.35).
NHB women with DCIS-MI present with higher nodal disease burden and experience worse disease-specific mortality than NHW women.
鉴于乳腺癌结局方面持续存在的种族差异，本研究旨在探讨微浸润性导管原位癌（DCIS-MI）患者的疾病特异性死亡率和手术管理方面的种族差异。
本研究通过查询监测、流行病学和最终结果（SEER）计划，纳入了 2010 年 1 月 1 日至 2018 年 12 月 31 日期间年龄在 18 岁及以上的 DCIS-MI 患者。研究队列分为非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）患者。使用 Cox 比例风险模型评估疾病特异性死亡率。
共纳入 3400 例患者，其中 569 例（16.7%）为 NHB，2831 例（83.3%）为 NHW。与 NHW 患者相比，NHB 患者的淋巴结阳性比例更高（7.6% vs. 3.9%，p<0.001）。此外，NHB 女性更倾向于接受腋窝淋巴结清扫术（6.0% vs. 3.8%，p=0.044）和化疗（11.8% vs. 7.2%，p<0.001）。两组间乳房手术类型（p=0.168）、重建手术（p=0.362）或放疗（p=0.342）无差异。总体而言，NHB 患者的疾病特异性死亡率更差（调整后的风险比 2.13，95%置信区间 [CI]：1.10-4.14），且死亡率风险在 3 年后（6 年风险比 [RR] 2.12，95% CI：1.13-4.34；9 年 RR 2.32，95% CI：1.24-4.35）与 NHW 女性出现差异。
患有 DCIS-MI 的 NHB 女性淋巴结疾病负担更高，疾病特异性死亡率较 NHW 女性更差。
