邻里劣势、建成环境与乳腺癌结局：肿瘤侵袭性和生存率的差异
Neighborhood Disadvantage, Built Environment, and Breast Cancer Outcomes: Disparities in Tumor Aggressiveness and Survival.
作者信息
Shen Jie, Guan Yufan, Gururaj Supraja, Zhang Kai, Song Qian, Liu Xin, Bear Harry D, Fuemmeler Bernard F, Anderson Roger T, Zhao Hua
机构信息
Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
Department of Population and Community Health, College of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA.
出版信息
Cancers (Basel). 2025 Apr 29;17(9):1502. doi: 10.3390/cancers17091502.
BACKGROUND
Breast cancer disparities persist globally, with growing evidence implicating neighborhood and built environmental factors in disease outcomes.
METHODS
This study investigates the associations between neighborhood disadvantage, environmental exposures, and breast tumor characteristics and survival among 3041 stage I-III breast cancer patients treated at the University of Virginia Comprehensive Cancer Center (2014-2024). Neighborhood disadvantage was assessed via the Area Deprivation Index (ADI), while environmental exposures included PM2.5, green space (NDVI), and food indices (modified retail food environment index (mRFEI), retail food activity index (RFAI)). Multivariable regression and Cox models adjusted for demographic, socioeconomic, and clinical covariates were employed.
RESULTS
A higher ADI score was associated with aggressive tumor characteristics, including advanced stage (Odds Ratio (OR) = 1.06, 95% Confidence Interval (CI):1.01-1.11), poor differentiation (OR = 1.07, 1.01-1.15), ER-negative status (OR = 1.06, 1.01-1.12), and triple-negative breast cancer (TNBC) (OR = 1.08, 1.02-1.16), as well as younger diagnosis age (β = -0.22, -0.36 to -0.09). PM2.5 exposure was correlated with advanced tumor stage (OR = 1.24, 1.09-1.40 for stage III) but paradoxically predicted improved survival (Hazard Ratio (HR) = 0.71, 0.63-0.82). The food environment indices showed subtype-specific survival benefits: higher mRFEI and RFAI scores were linked to reduced mortality in ER-negative (HR = 0.45, 0.23-0.85 and HR = 0.61, 0.38-0.97) and TNBC (HR = 0.40, 0.18-0.90 and HR = 0.48, 0.26-0.87) patients. NDVI scores exhibited no significant associations.
CONCLUSION
Our findings underscore the dual role of neighborhood disadvantage and the built environmental in breast cancer outcomes. While neighborhood disadvantage and PM2.5 exposure elevate tumor aggressiveness, survival disparities may be mediated by other factors. Improved food environments may enhance survival in aggressive subtypes, highlighting the need for integrated interventions addressing socioeconomic inequities, environmental risks, and nutritional support needs.
背景
全球乳腺癌差异持续存在，越来越多的证据表明社区和建成环境因素与疾病预后有关。
方法
本研究调查了弗吉尼亚大学综合癌症中心（2014 - 2024年）治疗的3041例I - III期乳腺癌患者中，社区劣势、环境暴露与乳腺肿瘤特征及生存之间的关联。通过区域剥夺指数（ADI）评估社区劣势，而环境暴露包括细颗粒物（PM2.5）、绿地（归一化植被指数，NDVI）和食物指数（改良零售食品环境指数（mRFEI）、零售食品活动指数（RFAI））。采用多变量回归和Cox模型，并对人口统计学、社会经济和临床协变量进行了调整。
结果
较高的ADI评分与侵袭性肿瘤特征相关，包括晚期（优势比（OR）= 1.06，95%置信区间（CI）：1.01 - 1.11）、低分化（OR = 1.07，1.01 - 1.15）、雌激素受体阴性状态（OR = 1.06，1.01 - 1.12）和三阴性乳腺癌（TNBC）（OR = 1.08，1.02 - 1.16），以及诊断年龄较小（β = -0.22，-0.36至-0.09）。PM2.5暴露与肿瘤晚期相关（III期的OR = 1.24，1.09 - 1.40），但反常地预示着生存改善（风险比（HR）= 0.71，0.63 - 0.82）。食物环境指数显示出亚型特异性的生存益处：较高的mRFEI和RFAI评分与雌激素受体阴性（HR = 0.45，0.23 - 0.85和HR = 0.61，0.38 - 0.97）和TNBC（HR = 0.40，0.18 - 0.90和HR = 0.48，0.26 - 0.87）患者的死亡率降低有关。NDVI评分未显示出显著关联。
结论
我们的研究结果强调了社区劣势和建成环境在乳腺癌预后中的双重作用。虽然社区劣势和PM2.5暴露会增加肿瘤侵袭性，但生存差异可能由其他因素介导。改善食物环境可能会提高侵袭性亚型的生存率，这突出了需要采取综合干预措施来解决社会经济不平等、环境风险和营养支持需求。
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