Shiao Y H, Chen V W, Lehmann H P, Wu X C, Correa P
Laboratory of Comparative Carcinogenesis, National Cancer Institute-Frederick Cancer Research and Development Center, NIH, Frederick, Maryland 21702, USA.
Clin Cancer Res. 1997 Apr;3(4):587-92.
A significant survival difference between black and white breast cancer patients has been observed in the United States. Evaluation of the prognostic value of DNA ploidy and S-phase fraction (SPF) in black and white breast cancer patients may contribute to our understanding of the mechanisms of racial disparity in survival. A sample of 98 patients (50 blacks and 48 whites) who participated in the Black/White Cancer Survival Study was selected for DNA flow cytometry analysis. Patients were followed between 4.5 and 6.5 years. The impacts of DNA ploidy and SPF on breast cancer survival were examined. Kaplan-Meier survival curves, log rank statistics, and Cox proportional hazards regression were used for survival analyses. Black patients were more likely than white patients to have tumors with high SPF (P < 0.05), but there was no difference in DNA ploidy (P = 0.79). Because there were significant interactions of both DNA ploidy and SPF with race, survival was examined separately for blacks and whites. Significantly poorer survival was observed for white patients with class A ploidy (hypodiploidy, hypotetraploidy, and hypertetraploidy; P = 0.001) and with high SPF (P = 0.025). The elevated hazard ratios remained significant after adjusting for age and stage. Further adjustment for adjuvant therapy and histopathological characteristics of tumor reduced the hazard ratios of SPF to a nonsignificant level. No significant associations were found between survival and DNA ploidy or SPF among blacks. DNA ploidy and SPF are prognostic factors for breast cancer survival in white patients but not in blacks. This may have clinical implication in breast cancer management.
在美国，已观察到黑人与白人乳腺癌患者之间存在显著的生存差异。评估DNA倍体和S期分数（SPF）在黑人和白人乳腺癌患者中的预后价值，可能有助于我们理解生存方面种族差异的机制。选取了98名参与黑/白癌症生存研究的患者（50名黑人患者和48名白人患者）作为样本进行DNA流式细胞术分析。对患者进行了4.5至6.5年的随访。研究了DNA倍体和SPF对乳腺癌生存的影响。采用Kaplan-Meier生存曲线、对数秩统计和Cox比例风险回归进行生存分析。黑人患者比白人患者更有可能出现SPF高的肿瘤（P < 0.05），但在DNA倍体方面没有差异（P = 0.79）。由于DNA倍体和SPF与种族均存在显著交互作用，因此分别对黑人和白人的生存情况进行了研究。观察到具有A类倍体（亚二倍体、亚四倍体和超四倍体；P = 0.001）和高SPF（P = 0.025）的白人患者生存情况明显较差。在调整年龄和分期后，升高的风险比仍然显著。进一步调整辅助治疗和肿瘤的组织病理学特征后，SPF的风险比降至无显著意义的水平。在黑人中未发现生存与DNA倍体或SPF之间存在显著关联。DNA倍体和SPF是白人患者而非黑人患者乳腺癌生存的预后因素。这可能对乳腺癌管理具有临床意义。
