Eley J W, Hill H A, Chen V W, Austin D F, Wesley M N, Muss H B, Greenberg R S, Coates R J, Correa P, Redmond C K
Division of Epidemiology, Emory University School of Public Health, Atlanta, GA 30322.
JAMA. 1994 Sep 28;272(12):947-54. doi: 10.1001/jama.272.12.947.
To examine the ability of recognized prognostic factors for breast cancer to account for the observed poorer survival in blacks compared with their white counterparts.
Subjects included 1130 women (612 blacks and 518 whites) aged 20 to 79 years residing in metropolitan Atlanta, Ga, New Orleans, La, or San Francisco/Oakland, Calif, who were diagnosed with primary invasive breast cancer. Information on stage, tumor characteristics, treatment, comorbid conditions, and sociodemographic factors was obtained from personal interview, physician and hospital records, and a pathology review of biopsy and surgical specimens.
Multivariable survival models were used to estimate the hazard ratio (relative risk of mortality) for blacks compared with whites, adjusting for various combinations of potential explanatory factors.
After controlling for geographic site and age, the risk of dying was 2.2 times (95% confidence interval [CI], 1.8 to 2.8) greater for blacks than whites. Adjustment for stage reduced the risk from 2.2 to 1.7; further adjustment for sociodemographic variables had no effect. Treatment was not a contributing factor once stage and tumor pathology were in the model. After adjusting for stage, treatment, comorbid illness, and pathologic and sociodemographic variables, blacks continued to demonstrate a slightly increased, but not statistically significant, risk of death (hazard ratio = 1.3; 95% CI, 1.0 to 1.8). Results were similar for all-cause mortality and breast cancer-specific mortality.
Approximately 75% of the racial difference in survival was explained by the prognostic factors studied. Sociodemographic variables appeared to act largely through racial differences in stage at diagnosis, which may be amenable to change through improved access to and use of screening for black women.
研究公认的乳腺癌预后因素能否解释黑人乳腺癌患者相较于白人患者生存情况较差这一现象。
研究对象包括1130名年龄在20至79岁之间、居住在佐治亚州亚特兰大市、路易斯安那州新奥尔良市或加利福尼亚州旧金山/奥克兰市的女性（612名黑人女性和518名白人女性），她们均被诊断为原发性浸润性乳腺癌。通过个人访谈、医生和医院记录以及活检和手术标本的病理检查，获取了有关分期、肿瘤特征、治疗、合并症以及社会人口学因素的信息。
使用多变量生存模型来估计黑人与白人相比的风险比（死亡相对风险），并对各种潜在解释因素的组合进行调整。
在控制地理位置和年龄后，黑人的死亡风险是白人的2.2倍（95%置信区间[CI]，1.8至2.8）。调整分期后，风险从2.2降至1.7；进一步调整社会人口学变量则没有效果。一旦分期和肿瘤病理因素纳入模型，治疗就不再是一个影响因素。在调整分期、治疗、合并症以及病理和社会人口学变量后，黑人的死亡风险仍略有增加，但无统计学意义（风险比 = 1.3；95% CI，1.0至1.8）。全因死亡率和乳腺癌特异性死亡率的结果相似。
所研究的预后因素解释了约75%的种族生存差异。社会人口学变量似乎主要通过诊断时分期的种族差异起作用，这可能通过改善黑人女性的筛查可及性和利用率而得到改变。
