Breast Cancer Mortality in African-American and Non-Hispanic White Women by Molecular Subtype and Stage at Diagnosis: A Population-Based Study.
Breast Cancer Mortality in African-American and Non-Hispanic White Women by Molecular Subtype and Stage at Diagnosis: A Population-Based Study.
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DOI：
10.1158/1055-9965.epi-15-0243
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Clarke CA
中科院分区：
文献类型：
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作者：
Tao L;Gomez SL;Keegan TH;Kurian AW;Clarke CA
非洲裔美国人的乳腺癌死亡率高于非西班牙裔白色女性，这是有据可查的;然而，仍然不确定这种差异是否发生在由肿瘤分子标志物和诊断阶段定义的疾病亚组中。我们在103，498例患者的多样化、基于人群的系列研究中，根据亚型和分期检查了结局的种族差异。我们获得了加州93,760名非西班牙裔白色和9,738名非裔美国妇女2005年1月1日至2012年12月31日诊断的所有浸润性乳腺癌的数据，并随访至2012年12月31日。根据激素受体（HR，基于雌激素和孕激素受体）和人表皮生长因子受体2（HER 2）的肿瘤表达对分子亚型进行分类。使用考克斯比例风险模型计算乳腺癌特异性死亡率的风险比（HR）和95%置信区间（CI）。在调整患者、肿瘤和治疗特征后，I期或IV期癌症（不考虑亚型）和HR+/HER 2+或HR-/HER 2+癌症（不考虑分期）的结局按人种相当。我们发现，与白人相比，患有II/III期HR+/HER 2-（HR，1.31，95% CI，1.03-1.65和HR，1.39，95% CI，1.10-1.75）和III期三阴性癌症的非裔美国女性的乳腺癌死亡风险显著更高。II/III期HR+/HER 2-和III期三阴性乳腺癌患者之间存在显著的种族/民族差异，但其他亚型和分期则无差异。这些数据为评估非洲裔美国人患者中特定亚型乳腺癌靶向治疗（例如曲妥珠单抗或内分泌治疗）的障碍提供了见解。
Higher breast cancer mortality rates for African-American than non-Hispanic white women are well documented; however, it remains uncertain if this disparity occurs in disease subgroups defined by tumor molecular markers and stage at diagnosis. We examined racial differences in outcome according to subtype and stage in a diverse, population-based series of 103,498 patients. We obtained data for all invasive breast cancers diagnosed 1/1/2005-12/31/2012 and followed through 12/31/2012 among 93,760 non-Hispanic white and 9,738 African-American women in California. Molecular subtypes were categorized according to tumor expression of hormone receptor (HR, based on estrogen and progesterone receptors) and human epidermal growth factor receptor 2 (HER2). Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer-specific mortality. After adjustment for patient, tumor and treatment characteristics, outcomes were comparable by race for Stage I or IV cancer regardless of subtype, and HR+/HER2+ or HR-/HER2+ cancer regardless of stage. We found substantially higher hazards of breast cancer death among African-American women with Stage II/III HR+/HER2- (HR, 1.31, 95% CI, 1.03-1.65, and HR, 1.39, 95% CI, 1.10-1.75, respectively) and Stage III triple-negative cancers relative to whites. There are substantial racial/ethnic disparities among patients with Stages II/III HR+/HER2- and Stage III triple-negative breast cancers but not for other subtype and stage. These data provide insights to assess barriers to targeted treatment (e.g. trastuzumab or endocrine therapy) of particular subtypes of breast cancer among African-American patients.