Vadlakonda Amulya, Chervu Nikhil L, Porter Giselle, Sakowitz Sara, Lee Hanjoo, Benharash Peyman, Kapoor Nimmi S
Department of Surgery, University of California, 15503 Ventura Blvd, Ste. 150, Encino, Los Angeles, CA, 91436, USA.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Breast Cancer Res Treat. 2025 Feb;210(1):15-25. doi: 10.1007/s10549-024-07531-3. Epub 2024 Nov 4.
As the US faces a diverse aging population, racial disparities in breast cancer outcomes among elderly patients remain poorly understood. We evaluate the association of race with presenting stage, treatment, and survival of invasive breast cancer among octogenarians.
Women (≥ 80 years) with invasive breast cancer were identified in 2004-2020 NCDB. To facilitate comparison, only non-Hispanic Black and non-Hispanic White patients were included; patients of Hispanic ethnicity were excluded. Demographics, tumor characteristics, and treatments were assessed by race. Overall survival was compared using the logrank test. Multivariable logistic and Cox proportional hazard regression models were developed to evaluate the independent association of race with outcomes of interest.
Of 222,897 patients, 19,059 (8.6%) were Black. Most patients had stage I ER + HER2- invasive ductal carcinoma. Black patients more frequently had greater comorbidities, low income and education, and advanced stage (p < 0.001 each; ref: White). Following adjustment, Black women had increased likelihood of Stage III/IV over time, as well as increased odds of chemotherapy (AOR 1.22, 95% CI 1.15 - 1.29) and non-operative management (AOR 1.82, 95% CI 1.72 - 1.92; ref: White). Although Black patients had lower survival rates compared to White, race was not associated with 5-year mortality following adjustment for stage, receipt of surgery, and adjuvant treatments (p = 0.34).
Inferior survival among elderly Black patients appears be driven by advanced stage at presentation. While such disparities are narrowing in the present era, future work must consider upstream interventions to ensure equitable outcomes for all races.
随着美国面临多样化的老年人口，老年患者乳腺癌治疗结果中的种族差异仍未得到充分了解。我们评估了八旬老人浸润性乳腺癌的种族与就诊分期、治疗及生存之间的关联。
在2004 - 2020年的国家癌症数据库中识别出患有浸润性乳腺癌的女性（≥80岁）。为便于比较，仅纳入非西班牙裔黑人和非西班牙裔白人患者；排除西班牙裔患者。按种族评估人口统计学、肿瘤特征和治疗情况。使用对数秩检验比较总生存情况。建立多变量逻辑回归和Cox比例风险回归模型，以评估种族与感兴趣结局之间的独立关联。
在222,897例患者中，19,059例（8.6%）为黑人。大多数患者患有I期雌激素受体阳性、人表皮生长因子受体2阴性浸润性导管癌。黑人患者更常伴有更多合并症、低收入和低教育水平，且分期较晚（每项p < 0.001；对照：白人）。经过调整后，随着时间推移，黑人女性处于III/IV期的可能性增加，接受化疗（优势比1.22，95%置信区间1.15 - 1.29）和非手术治疗（优势比1.82，95%置信区间1.72 - 1.92；对照：白人）的几率也增加。尽管与白人相比，黑人患者生存率较低，但在对分期、手术接受情况和辅助治疗进行调整后，种族与5年死亡率无关（p = 0.34）。
老年黑人患者生存率较低似乎是由就诊时分期较晚所致。虽然在当前时代这种差异正在缩小，但未来的工作必须考虑上游干预措施，以确保所有种族都能获得公平的治疗结果。
