Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study.
Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study.
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DOI：
10.1158/1078-0432.ccr-10-1533
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发表时间：
2010-12-15
期刊：
影响因子：
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通讯作者：
Millikan RC
中科院分区：
文献类型：
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作者：
O'Brien KM;Cole SR;Tse CK;Perou CM;Carey LA;Foulkes WD;Dressler LG;Geradts J;Millikan RC
先前的研究确定了四种“内在”肿瘤亚型的乳腺癌特异性死亡率的差异：管腔A型、管腔B型、基底样型和人表皮生长因子受体2阳性/雌激素受体阴性（HER 2 +/ER−）。在卡罗莱纳乳腺癌研究中，我们使用免疫组化标记物对1149例浸润性乳腺癌患者（518例非裔美国人，631例白色人）进行分型，这是一项以人群为基础的乳腺癌女性研究。使用国家死亡指数确定了2006年的生命状态，中位随访时间为9年。白人中，腔A型、腔B型、基底细胞样和HER 2 +/ER-癌症亚型的分布分别为64%、11%、11%和5%，非裔美国人中分别为48%、8%、22%和7%。与管腔A和B相比，HER 2 +/ER-和基底细胞样乳腺癌患者的乳腺癌死亡率更高。非裔美国人的乳腺癌特异性死亡率高于白人，但种族的影响仅在管腔A型乳腺癌女性中具有统计学意义。然而，当与人种分类中的管腔A亚型相比时，白人基底细胞样乳腺癌患者的死亡率（HR=2.0，95% CI：1.2，3.4）高于非裔美国人（HR=1.5，95% CI：1.0，2.4），在绝经后白色女性中观察到最强的影响（HR=3.9，95% CI：1.5，10.0）。我们的研究结果证实了基底细胞样乳腺癌与预后不良的相关性，并表明与白人相比，基底细胞样乳腺癌在非洲裔美国妇女中并不是一种固有的更具侵袭性的疾病。需要在已知治疗特征的人群中进行额外的分析，以了解肿瘤亚型和种族在乳腺癌死亡率中的作用，特别是我们发现，在患有管腔A型乳腺癌的女性中，非洲裔美国人的死亡率高于白人。
Previous research identified differences in breast cancer-specific mortality across four "intrinsic" tumor subtypes: luminal A, luminal B, basal-like, and human epidermal growth factor receptor 2 positive/estrogen receptor negative (HER2+/ER−). We used immunohistochemical markers to subtype 1149 invasive breast cancer patients (518 African American, 631 white) in the Carolina Breast Cancer Study, a population-based study of women diagnosed with breast cancer. Vital status was determined through 2006 using the National Death Index, with median follow-up of 9 years. Cancer subtypes luminal A, luminal B, basal-like and HER2+/ER- were distributed as 64%, 11%, 11% and 5% for whites, and 48%, 8%, 22% and 7% for African Americans, respectively. Breast cancer mortality was higher for patients with HER2+/ER- and basal-like breast cancer compared to luminal A and B. African Americans had higher breast-cancer specific mortality than whites, but the effect of race was statistically significant only among women with luminal A breast cancer. However, when compared to the luminal A subtype within racial categories, mortality for patients with basal-like breast cancer was higher among whites (HR=2.0, 95% CI: 1.2, 3.4) than African Americans (HR=1.5, 95% CI: 1.0, 2.4), with the strongest effect seen in postmenopausal white women (HR=3.9, 95% CI: 1.5, 10.0). Our results confirm the association of basal-like breast cancer with poor prognosis, and suggest that basal-like breast cancer is not an inherently more aggressive disease in African American women compared to whites. Additional analyses are needed in populations with known treatment profiles to understand the role of tumor subtypes and race in breast cancer mortality, and in particular our finding that among women with luminal A breast cancer, African Americans have higher mortality than whites.