Ethnic Differences in Survival after Breast Cancer in South East Asia
Ethnic Differences in Survival after Breast Cancer in South East Asia
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DOI：
10.1371/journal.pone.0030995
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发表时间：
2012-02-21
期刊：
影响因子：
3.7
通讯作者：
Verkooijen, Helena M.
中科院分区：
文献类型：
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作者：
Bhoo-Pathy, Nirmala;Hartman, Mikael;Verkooijen, Helena M.
背景：亚洲乳腺癌的负担正在升级。我们评估了种族对东南亚多民族地区乳腺癌术后生存率的影响。方法/主要研究结果：利用新加坡-马来西亚医院的乳腺癌登记，我们分析了1990至2007年间确诊的5,264名乳腺癌患者中种族与乳腺癌死亡率的关系(华人：71.6%，马来人：18.4%，印度人：10.0%)。我们比较了不同种族之间的存活率，并计算了调整后的危险比(HR)，以评估种族对生存的独立影响。与中国人和印度人相比，马来人(n=968)的发病年龄明显更小，肿瘤更大，而且出现的时间更晚。在肿瘤大小相似的情况下，马来人也更有可能有腋窝淋巴结转移，并且有激素受体阴性和低分化的肿瘤。中国女性的五年总生存率最高(75.8%；95%CI：74.4%-77.3%)，其次是印度女性(68.0%；95%CI：63.8%-72.2%)和马来女性(58.5%；95%CI：55.2%-61.7%)。与华裔相比，马来族与全因死亡率显著相关(HR：1.34；95%CI：1.19-1.51)，与年龄、分期、肿瘤特征和治疗无关。与中国人相比，印度民族与乳腺癌后死亡风险没有显著相关性(HR：1.14；95%CI：0.98-1.34)。结论：在东南亚，马来族与乳腺癌后较差的生存独立相关。对潜在原因进行研究，可能包括肿瘤生物学、心理社会因素、治疗反应和确诊后的生活方式的变化，是必要的。
Background: The burden of breast cancer in Asia is escalating. We evaluated the impact of ethnicity on survival after breast cancer in the multi-ethnic region of South East Asia.Methodology/Principal Findings: Using the Singapore-Malaysia hospital-based breast cancer registry, we analyzed the association between ethnicity and mortality following breast cancer in 5,264 patients diagnosed between 1990 and 2007 (Chinese: 71.6%, Malay: 18.4%, Indian: 10.0%). We compared survival rates between ethnic groups and calculated adjusted hazard ratios (HR) to estimate the independent effect of ethnicity on survival. Malays (n = 968) presented at a significantly younger age, with larger tumors, and at later stages than the Chinese and Indians. Malays were also more likely to have axillary lymph node metastasis at similar tumor sizes and to have hormone receptor negative and poorly differentiated tumors. Five year overall survival was highest in the Chinese women (75.8%; 95%CI: 74.4%-77.3%) followed by Indians (68.0%; 95%CI: 63.8%-72.2%), and Malays (58.5%; 95%CI: 55.2%-61.7%). Compared to the Chinese, Malay ethnicity was associated with significantly higher risk of all-cause mortality (HR: 1.34; 95%CI: 1.19-1.51), independent of age, stage, tumor characteristics and treatment. Indian ethnicity was not significantly associated with risk of mortality after breast cancer compared to the Chinese (HR: 1.14; 95%CI: 0.98-1.34).Conclusion: In South East Asia, Malay ethnicity is independently associated with poorer survival after breast cancer. Research into underlying reasons, potentially including variations in tumor biology, psychosocial factors, treatment responsiveness and lifestyle after diagnosis, is warranted.