Anampa Jesus D, Alvarez Soto Alvaro, Bernal Ana M, Acuna-Villaorduna Ana
Department of Medical Oncology, Montefiore Einstein Comprehensive Cancer Center, 1695 Eastchester Rd, 2nd Floor, Bronx, NY, 10461, USA.
Department of Medicine, Hematology/Oncology, Carole and Ray Neag Comprehensive Cancer Center, UCONN Health, Farmington, CT, USA.
Breast Cancer Res Treat. 2025 Apr;210(2):307-317. doi: 10.1007/s10549-024-07565-7. Epub 2024 Nov 26.
Triple-negative breast cancer (TNBC) is an aggressive breast cancer (BC) subtype with higher incidence and mortality rates in non-Hispanic Black (NHB) women than non-Hispanic Whites. Studies assessing disparities between NHB and Hispanic women, the two largest US racial/ethnic minorities, are lacking. This study evaluates disparities in the treatment and outcomes between NHB and Hispanic women with non-metastatic TNBC.
This observational, population-based study using the SEER database included adult, female patients diagnosed with non-metastatic TNBC between 2010 and 2015 and identified as NHB or Hispanic. Logistic regression analysis was used to examine the adjusted odds of receiving breast cancer-directed treatment. Kaplan-Meier and cumulative incidence of death curves were plotted to assess overall survival (OS) and risk of breast cancer-related death, respectively. Multivariate regression analyses with Cox and Fine-Gray methods were calculated to assess factors associated with OS and breast cancer-related death, respectively.
There were 3426 Hispanic and 5419 NHB patients with non-metastatic TNBC. Hispanics had better 5-year OS relative to NHB (76% vs. 72%). No differences in the odds of receiving chemotherapy or surgery between cohorts was seen. However, the odds of undergoing breast-conserving surgery (BCS) and receiving radiation was higher in NHB than Hispanics, (OR, 1.22; 95% CI, 1.10-1.36) and (OR, 1.50; 95% CI, 1.36-1.66), respectively. Lack of radiation therapy was associated with increased BC-related death in NHB relative to Hispanics (sHR, 1.40; 95% CI, 1.19-1.65). Nevertheless, this difference was not seen when radiation was given, (sHR, 1.03; 95% CI, 0.87-1.23).
We found racial disparities in treatment and outcomes between NHB and Hispanics. NHB were more likely to receive radiation therapy and have BCS. Still, after adjusting for demographic and treatment-related factors, NHB had worse OS and BCSS relative to Hispanics. Additional research is needed to understand the drivers of these disparities.
三阴性乳腺癌（TNBC）是一种侵袭性乳腺癌亚型，在非西班牙裔黑人（NHB）女性中的发病率和死亡率高于非西班牙裔白人。目前缺乏评估NHB女性与西班牙裔女性（美国两个最大的种族/族裔少数群体）之间差异的研究。本研究评估了非转移性TNBC的NHB女性和西班牙裔女性在治疗及预后方面的差异。
本项基于人群的观察性研究使用了监测、流行病学和最终结果（SEER）数据库，纳入了2010年至2015年间被诊断为非转移性TNBC的成年女性患者，并确定其为NHB或西班牙裔。采用逻辑回归分析来检验接受乳腺癌定向治疗的校正比值比。绘制Kaplan-Meier曲线和累积死亡发生率曲线，分别评估总生存期（OS）和乳腺癌相关死亡风险。分别采用Cox和Fine-Gray方法进行多变量回归分析，以评估与OS和乳腺癌相关死亡相关的因素。
共有3426名西班牙裔和5419名NHB患者患有非转移性TNBC。与NHB相比，西班牙裔的5年总生存率更高（76%对72%）。两组在接受化疗或手术的几率上没有差异。然而，NHB接受保乳手术（BCS）和放疗的几率高于西班牙裔，分别为（比值比，1.22；95%置信区间，1.10 - 1.36）和（比值比，1.50；95%置信区间，1.36 - 1.66）。与西班牙裔相比，NHB缺乏放疗与乳腺癌相关死亡增加有关（标准化危险比，1.40；95%置信区间，1.19 - 1.65）。然而，在进行放疗时未观察到这种差异（标准化危险比，1.03；95%置信区间，0.87 - 1.23）。
我们发现NHB和西班牙裔在治疗及预后方面存在种族差异。NHB更有可能接受放疗和保乳手术。尽管如此，在调整人口统计学和治疗相关因素后，与西班牙裔相比，NHB的总生存期和乳腺癌特异性生存期更差。需要进一步的研究来了解这些差异的驱动因素。
