RACIAL-DIFFERENCES IN SURVIVAL FROM BREAST-CANCER - RESULTS OF THE NATIONAL-CANCER-INSTITUTE BLACK/WHITE CANCER SURVIVAL STUDY
RACIAL-DIFFERENCES IN SURVIVAL FROM BREAST-CANCER - RESULTS OF THE NATIONAL-CANCER-INSTITUTE BLACK/WHITE CANCER SURVIVAL STUDY
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DOI：
10.1001/jama.272.12.947
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发表时间：
1994-09-28
影响因子：
120.7
通讯作者：
EDWARDS, BK
中科院分区：
文献类型：
--
作者：
ELEY, JW;HILL, HA;EDWARDS, BK
客观。-为了研究乳腺癌的公认预后因素的能力，以解释观察到的黑人生存率低于他们的白色同行。受试者包括1130名女性（612名黑人和518名白人），年龄20至79岁，居住在亚特兰大、佐治亚州、新奥尔良、路易斯安那州或旧金山弗朗西斯科/奥克兰、加利福尼亚州，被诊断为原发性浸润性乳腺癌。从个人访谈、医生和医院记录以及活检和手术标本的病理学回顾中获得关于分期、肿瘤特征、治疗、共病情况和社会人口学因素的信息。多变量生存模型用于估计黑人与白人相比的风险比（相对死亡风险），调整潜在解释因素的各种组合。在控制了地理位置和年龄后，黑人的死亡风险是白人的2.2倍（95%置信区间[CI]，1.8 - 2.8）。调整阶段的风险从2.2降低到1.7;进一步调整社会人口学变量没有影响。一旦模型中存在分期和肿瘤病理学，治疗就不是影响因素。在调整了分期、治疗、共病、病理和社会人口统计学变量后，黑人死亡风险继续略有增加，但无统计学显著性（风险比=1.3; 95%CI，1.0 - 1.8）。全因死亡率和乳腺癌特异性死亡率的结果相似。大约75%的生存率种族差异是由研究的预后因素解释的。社会人口学变量似乎主要通过诊断阶段的种族差异来发挥作用，通过改善黑人女性获得和使用筛查的机会，这种差异可能会发生变化。
Objective.-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.Design and Participants.-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.Main Outcome Measure.-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.Results.-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.Conclusions.-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.