Elledge R M, Clark G M, Chamness G C, Osborne C K
University of Texas Health Science Center, Division of Medical Oncology, San Antonio 78284-7884.
J Natl Cancer Inst. 1994 May 4;86(9):705-12. doi: 10.1093/jnci/86.9.705.
In the United States, prognosis and survival after the diagnosis of breast cancer is poorer among black patients and, to a lesser extent, among Hispanic patients, compared with white patients. Patients who are black or Hispanic have been reported to present with higher stage or more advanced disease. Even after adjusting for stage, however, survival rates are lower for blacks but not for Hispanics.
Our purpose was to compare survival, age, tumor size, nodal status, estrogen-receptor (ER) and progesterone-receptor (PgR) status, histologic type, S-phase fraction, DNA ploidy status, HER-2/neu protein expression, and p53 protein status, along with systemic treatment, in a large group of white, black, and Hispanic U.S. women.
From 1970 to 1991, breast tumor specimens were submitted to The University of Texas Health Science Center from 31 contributing hospitals throughout the United States for ER and PgR assay. A total of 4885 white, 1016 black, and 777 Hispanic women were eligible for this study. Median follow-up was 57 months.
Overall, white women were significantly more likely to be older and to have smaller tumors, have less lymph node involvement, have tumors with positive ER and PgR status, and have a lower S-phase fraction compared with Hispanic or black women. There were no clinically important differences in DNA ploidy, histologic type, HER-2/neu, and p53 expression among the three groups. Considering all stages, white women had the best overall survival (date of diagnosis to date of death) at 5 years--75% +/- 1% (means +/- SE), with a median survival of 166 months, but Hispanic women had an intermediate survival--70% +/- 2% (median survival, 156 months), and black women had the worst survival--65% +/- 2% (median survival, 117 months) (P < .0001). For node-negative patients, there was no significant difference in disease-free survival (date of diagnosis to date of first recurrence) or overall survival, although blacks tended to have a worse prognosis. For node-positive or locally advanced disease and for metastatic disease, blacks had significantly (P < .0001) worse disease-free and overall survival than did white or Hispanic women. Differences in the use of systemic therapy did not explain these outcomes.
A number of biologic factors associated with poor prognosis are found with a significantly increased frequency in breast tumors from Hispanic and, particularly, from black women. Tumors with a more aggressive biology could lead to a higher stage at diagnosis and a poorer survival for the group as a whole.
在美国，与白人患者相比，乳腺癌确诊后的黑人患者预后和生存率较差，西班牙裔患者的情况相对稍好。据报道，黑人或西班牙裔患者所患疾病分期更高或病情更严重。然而，即便对分期进行调整后，黑人患者的生存率仍较低，而西班牙裔患者则不然。
我们旨在比较一大批美国白人、黑人及西班牙裔女性在生存率、年龄、肿瘤大小、淋巴结状态、雌激素受体（ER）和孕激素受体（PgR）状态、组织学类型、S期分数、DNA倍体状态、HER-2/neu蛋白表达以及p53蛋白状态，以及全身治疗方面的差异。
1970年至1991年期间，来自美国各地31家参与研究的医院将乳腺肿瘤标本提交至德克萨斯大学健康科学中心进行ER和PgR检测。共有4885名白人女性、1016名黑人女性和777名西班牙裔女性符合本研究要求。中位随访时间为57个月。
总体而言，与西班牙裔或黑人女性相比，白人女性年龄更大、肿瘤更小、淋巴结受累情况更少、肿瘤ER和PgR状态为阳性且S期分数更低的可能性显著更高。三组在DNA倍体、组织学类型、HER-2/neu及p53表达方面无临床重要差异。考虑所有分期，白人女性5年总生存率（从确诊到死亡日期）最佳，为75%±1%（均值±标准误），中位生存期为166个月；西班牙裔女性生存率居中，为70%±2%（中位生存期156个月）；黑人女性生存率最差，为65%±2%（中位生存期117个月）（P<0.0001）。对于淋巴结阴性患者，无病生存率（从确诊到首次复发日期）或总生存率无显著差异，尽管黑人患者预后往往较差。对于淋巴结阳性或局部晚期疾病以及转移性疾病，黑人患者的无病生存率和总生存率显著（P<0.0001）低于白人或西班牙裔女性。全身治疗使用情况的差异无法解释这些结果。
在西班牙裔尤其是黑人女性的乳腺肿瘤中，发现了一些与预后不良相关的生物学因素，其出现频率显著增加。生物学行为更具侵袭性的肿瘤可能导致确诊时分期更高，进而使整个群体的生存率更低。
