Yoshikawa Gene T, Miyazaki Kyle Sy, Acoba Jared D, Fujii Takeo
Department of Medicine, University of Hawai'i Internal Medicine Residency Program, Honolulu, HI, United States.
John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, United States.
Front Oncol. 2024 May 17;14:1390080. doi: 10.3389/fonc.2024.1390080. eCollection 2024.
It is well known that race is an independent predictor of breast cancer mortality and advanced stage at diagnosis. Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer and has distinct clinical and biological features. Previous studies have shown that Blacks have a higher incidence of IBC than Whites. However, the proportion of IBC and the role of race on prognosis in Native Hawaiian and other Pacific Islander (NH/PI) populations with breast cancer are poorly understood. In this study, we aimed to examine the proportion of IBC to non-IBC in NH/PIs and to identify the clinicopathological, biological, and socioeconomic factors associated with the overall survival of NH/PIs compared to other races.
Utilizing a comprehensive cancer registry from the largest hospital in Hawaii, newly diagnosed primary invasive breast cancer patients diagnosed between 2000 and 2018 were identified. Univariate and multivariate Cox proportional hazards models were used to test the association between race and clinical outcomes. Variables with P-values <0.05 in the univariate analysis and race (variable of interest) were included in a multivariate analysis.
The cohort included 3691 patients, 60 of whom had IBC. NH/PI race had the highest proportion of IBC compared to other races (3.44%) but was not found to be an independent poor prognostic factor in IBC (HR 1.17 [95%CI 0.26-5.22]). Conversely, NH/PI race was associated with worse survival outcomes in patients with non-IBC (HR 1.65 [95%CI, 1.14-2.39]) along with other factors such as lack of insurance, underinsured status, triple-negative breast cancer (TNBC) subtype, age, and advanced clinical stage.
The findings of this study highlight that NH/PIs had higher rates of IBC and inferior survival in non-IBC compared to other races but not in IBC. It is essential to disaggregate NH/PI race from Asians in future population-based research studies. Further research is needed to understand the factors contributing to higher rates of IBC and poor survival outcomes in NH/PIs with non-IBC as well as targeted interventions to improve breast cancer outcomes in this population to ultimately help improve survival rates and reduce health inequities in NH/PIs with breast cancer.
众所周知，种族是乳腺癌死亡率和诊断时晚期阶段的独立预测因素。炎性乳腺癌（IBC）是最具侵袭性的乳腺癌类型，具有独特的临床和生物学特征。先前的研究表明，黑人的IBC发病率高于白人。然而，对于夏威夷原住民和其他太平洋岛民（NH/PI）乳腺癌患者中IBC的比例以及种族对预后的作用，人们了解甚少。在本研究中，我们旨在研究NH/PI人群中IBC与非IBC的比例，并确定与NH/PI人群与其他种族相比总体生存相关的临床病理、生物学和社会经济因素。
利用夏威夷最大医院的综合癌症登记处，确定2000年至2018年间新诊断的原发性浸润性乳腺癌患者。单因素和多因素Cox比例风险模型用于检验种族与临床结局之间的关联。单因素分析中P值<0.05的变量和种族（感兴趣的变量）纳入多因素分析。
该队列包括3691名患者，其中60人患有IBC。与其他种族相比，NH/PI种族的IBC比例最高（3.44%），但未发现是IBC的独立不良预后因素（风险比1.17[95%置信区间0.26 - 5.22]）。相反，NH/PI种族与非IBC患者较差的生存结局相关（风险比1.65[95%置信区间，1.14 - 2.39]），以及其他因素，如缺乏保险、保险不足状态、三阴性乳腺癌（TNBC）亚型、年龄和晚期临床阶段。
本研究结果突出表明，与其他种族相比，NH/PI人群的IBC发病率较高，非IBC患者的生存率较低，但IBC患者并非如此。在未来基于人群的研究中，将NH/PI种族与亚洲人区分开来至关重要。需要进一步研究以了解导致NH/PI人群中IBC发病率较高和非IBC患者生存结局较差的因素，以及针对性干预措施，以改善该人群的乳腺癌结局，最终帮助提高NH/PI乳腺癌患者的生存率并减少健康不平等。
