Insights from Asian Populations into Disparities in Breast Cancer Prognosis and Outcomes

摘要 亚裔美国妇女的癌症生存率比其他美国种族/族裔群体更高， 在考虑了已知的预后指标后。乳腺癌，遵循这种模式，是一个有用的模型， 了解促成这种有趣的生存优势的因素，因为它是最常见的 亚裔美国妇女的癌症，并已建立了临床，生物学/遗传学和生活方式预后 因素因此，研究亚裔美国妇女的乳腺癌生存优势有可能 确定可能对所有患者有益的保护因素。我们建议调查多层次因素（健康 行为和背景因素，临床特征，治疗和肿瘤免疫应答） 亚裔美国人乳腺癌病例的总体和乳腺癌特异性死亡率。然而，亚洲 美国人口是异质性的，有生活方式因素和疾病风险（例如，乳腺癌存活 根据具体的种族和移民身份而有所不同。许多研究表明， 人口分类，以揭示亚裔美国人族裔群体之间有意义的差异，但没有 迄今为止的一项研究包括了足够的亚裔美国人种族群体样本。为了克服这个 限制，我们将进行综合数据和生物标本，从四个建立拟议的研究 亚裔美国人乳腺癌病例的队列研究。这些研究共包括4，219名亚洲人 美国患者（1，848名中国人，602名日本人，1，538名菲律宾人）和5，386名非拉丁裔白色女性， 乳腺癌作为对照组。在具体目标1中，我们将评估个人生活方式的贡献 健康行为和多层次邻里社会背景和社会文化因素对生存的影响 亚裔美国人与非拉丁裔白人之间的差异。在第二阶段，我们将 评估特定治疗因素如何影响4，373名亚裔美国人与4，373名非亚裔美国人的生存率。 拉丁白人，利用电子健康记录数据从平等获得医疗保健系统。在 具体目标3，我们将从1，200例乳腺肿瘤微环境中表征免疫浸润 亚裔美国人（来自Aim 1）和714例非拉丁裔白色（来自TCGA）患者使用免疫基因组学分析， 并确定免疫表型与亚裔美国人患者生存率的关系， 目标1中的暴露因子。因此，利用现有资源，本研究将全面评估 因素包括健康行为和邻里环境，生活方式，治疗，肿瘤免疫生物学， 他们对亚裔美国妇女生存优势的贡献。这项研究使效率 使用来自众多乳腺癌研究的数据，以深入了解可能促进知识的策略 关于所有女性乳腺癌的管理

Abstract Asian American women experience more favorable cancer survival than other US racial/ethnic groups, even after accounting for known prognostic indicators. Breast cancer, which follows this pattern, is a useful model for understanding factors contributing to this intriguing survival advantage, given that it is the most common cancer in Asian American women, and has established clinical, biological/genetic, and lifestyle prognostic factors. Thus, studying the breast cancer survival advantage in Asian American women has the potential to identify protective factors that may benefit all patients. We propose to investigate multilevel factors (health behaviors and contextual factors, clinical characteristics, treatment, and tumor immune response) in relation to overall and breast cancer-specific mortality in Asian American breast cancer cases. However, the Asian American population is heterogeneous, with lifestyle factors and disease risks (e.g., breast cancer survival rates) varying by specific ethnicity and by immigration status. Many studies have shown the importance of population disaggregation to uncovering meaningful differences among Asian American ethnic groups, but no single study to date includes adequate Asian American ethnic group population samples. To overcome this limitation, we will conduct the proposed research in integrated data and biospecimens from four established cohort studies enriched with Asian American breast cancer cases. These studies together include 4,219 Asian American patients (1,848 Chinese, 602 Japanese, 1,538 Filipinas) and 5,386 non-Latina White women with breast cancer as a comparison group. In Specific Aim 1, we will assess contributions of individual-level lifestyle and health behaviors and multilevel neighborhood social context and sociocultural factors to survival differences among the Asian American ethnic groups relative to non-Latina Whites. In Specific Aim 2, we will evaluate how specific treatment factors impact survival for 4,373 Asian Americans compared to 4,373 non- Latina Whites, taking advantage of electronic health record data from an equal-access healthcare system. In Specific Aim 3, we will characterize the immune infiltrates in the breast tumor microenvironment from 1,200 Asian American (from Aim 1) and 714 non-Latina White (from TCGA) patients using immunogenomic profiling, and to determine the associations of immune phenotypes with patient survival among Asian Americans and with exposure factors from Aim 1. Thus, using existing resources, this study will comprehensively assess factors including health behaviors and neighborhood context, lifestyle, treatment, tumor immuno-biology, and their contributions to the survival advantage in Asian American women. The proposed study makes efficient use of data from numerous breast cancer studies to gain insight for strategies that may advance knowledge about the management of breast cancer for all women.