Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors
Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors
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DOI：
10.1200/jco.2014.57.1349
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发表时间：
2015-07-10
影响因子：
45.3
通讯作者：
Partridge, Ann H.
中科院分区：
文献类型：
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作者：
Warner, Erica T.;Tamimi, Rulla M.;Partridge, Ann H.
目的探讨种族/民族与乳腺癌亚型特异性生存的关系，并探讨其介导因素。患者和方法：研究对象为2000年1月至2007年12月在国家综合癌症网络中心进行的I至III期乳腺癌患者，随访至2009年12月。采用Cox比例风险回归比较亚洲人（n = 533）、西班牙裔（n = 1122）和黑人（n = 1345）与白人（n = 14268）的乳腺癌特异性生存率，并按亚型（管腔A样、管腔B样、人表皮生长因子受体2型和三阴性）进行总体和分层。模型估计用于得出选定危险因素的中介比例和95% CI。结果在多变量调整模型中，总体而言，黑人乳腺癌特异性死亡风险高出21%（风险比[HR]， 1.21; 95% CI, 1.00 ~ 1.45）。对于雌激素受体阳性肿瘤，黑人和白人在诊断后2年内的生存差异最大（0至2年：HR， 2.65; 95% CI， 1.34至5.24；第2年至随访结束：HR， 1.50; 95% CI， 1.12至2.00）。黑人死于管腔a样和管腔b样肿瘤的可能性分别高出76%和56%。在三阴性或人表皮生长因子受体2型肿瘤中没有观察到差异。与白人相比，亚洲人和西班牙人死于乳腺癌的可能性更小（亚洲人：HR， 0.56; 95% CI， 0.37至0.85；西班牙人：HR， 0.74; 95% CI， 0.58至0.95）。对于黑人，肿瘤特征和诊断分期是显著的差异中介。身体质量指数是黑人和亚洲人的重要中介。结论乳腺癌生存的种族差异因肿瘤亚型而异。需要采取干预措施来减少差异，特别是在患有雌激素受体阳性肿瘤的黑人妇女诊断后的头两年。(C) 2015年由美国临床肿瘤学会出版
PurposeTo evaluate the relationship between race/ethnicity and breast cancer-specific survival according to subtype and explore mediating factors.Patients and MethodsParticipants were women presenting with stage I to III breast cancer between January 2000 and December 2007 at National Comprehensive Cancer Network centers with survival follow-up through December 2009. Cox proportional hazards regression was used to compare breast cancer-specific survival among Asians (n = 533), Hispanics (n = 1,122), and blacks (n = 1,345) with that among whites (n = 14,268), overall and stratified by subtype (luminal A like, luminal B like, human epidermal growth factor receptor 2 type, and triple negative). Model estimates were used to derive mediation proportion and 95% CI for selected risk factors.ResultsIn multivariable adjusted models, overall, blacks had 21% higher risk of breast cancer-specific death (hazard ratio [HR], 1.21; 95% CI, 1.00 to 1.45). For estrogen receptor-positive tumors, black and white survival differences were greatest within 2 years of diagnosis (years 0 to 2: HR, 2.65; 95% CI, 1.34 to 5.24; year 2 to end of follow-up: HR, 1.50; 95% CI, 1.12 to 2.00). Blacks were 76% and 56% more likely to die as a result of luminal A-like and luminal B-like tumors, respectively. No disparities were observed for triple-negative or human epidermal growth factor receptor 2-type tumors. Asians and Hispanics were less likely to die as a result of breast cancer compared with whites (Asians: HR, 0.56; 95% CI, 0.37 to 0.85; Hispanics: HR, 0.74; 95% CI, 0.58 to 0.95). For blacks, tumor characteristics and stage at diagnosis were significant disparity mediators. Body mass index was an important mediator for blacks and Asians.ConclusionRacial disparities in breast cancer survival vary by tumor subtype. Interventions are needed to reduce disparities, particularly in the first 2 years after diagnosis among black women with estrogen receptor-positive tumors. (C) 2015 by American Society of Clinical Oncology