Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ
Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ
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DOI：
10.1002/cncr.32200
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发表时间：
2019-09-15
期刊：
影响因子：
6.2
通讯作者：
Colditz, Graham A.
中科院分区：
文献类型：
--
作者：
Liu, Ying;West, Robert;Colditz, Graham A.
背景与白人相比，普通黑人女性患乳腺癌的风险更高，雌激素受体(ER)和孕激素受体(PR)均为阴性。在发生侵袭性浸润性乳腺癌(IBC)的风险方面，种族差异尚不清楚，IBC的特征是ER和PR均为阴性(ER-PR-)或导管原位癌(DCIS)后较高的21基因复发评分。方法这项研究从监测、流行病学和最终结果数据集中确定了163,892名女性(10.5%是黑人，9.8%是亚裔，8.6%是西班牙裔)在1990年至2015年期间发生了DCIS。根据激素受体状态和21基因复发评分，用COX比例风险回归估计后续IBC的风险比(HR)。结果在90个月的中位随访期内，8333名妇女发生了IBC。与白人女性相比，黑人女性(10年绝对差异，2.2%)和亚洲女性(10年绝对差异，0.4%)患ER-PR-乳腺癌的调整后的HR分别为1.86(95%可信区间，1.57-2.20)和1.40(95%可信区间，1.14-1.71)；这比ER+和/或PR+亚型的相关性更强(P-异质性=.0004)。随后的早期ER+IBCs的21基因复发分数因种族/民族而异(P-异质性=0.057)；黑人女性比白人女性更有可能复发分数为26或更高(HR，1.38；95%CI，1.00-1.92)。在西班牙裔女性随后发生IBC亚型的风险方面没有显著差异。结论与白人女性相比，患有DCIS的黑人和亚裔女性患侵袭性IBC的风险更高。这一点应该在黑人和亚洲DCIS患者的治疗决策中考虑到。
Background General populations of black women have a higher risk of developing breast cancer negative for both estrogen receptor (ER) and progesterone receptor (PR) in comparison with white counterparts. Racial differences remain unknown in the risk of developing aggressive invasive breast cancer (IBC) that is characterized by negativity for both ER and PR (ER-PR-) or higher 21-gene recurrence scores after ductal carcinoma in situ (DCIS). Methods This study identified 163,892 women (10.5% black, 9.8% Asian, and 8.6% Hispanic) with incident DCIS between 1990 and 2015 from the Surveillance, Epidemiology, and End Results data sets. Cox proportional hazards regression was used to estimate hazards ratios (HRs) of subsequent IBC classified by the hormone receptor status and 21-gene recurrence scores. Results During a median follow-up of 90 months, 8333 women developed IBC. In comparison with white women, the adjusted HR of subsequent ER-PR- breast cancer was 1.86 (95% confidence interval [CI], 1.57-2.20) for black women (absolute 10-year difference, 2.2%) and 1.40 (95% CI, 1.14-1.71) for Asian women (absolute 10-year difference, 0.4%); this was stronger than the associations for ER+ and/or PR+ subtypes (P-heterogeneity = .0004). The 21-gene recurrence scores of subsequent early-stage, ER+ IBCs varied by race/ethnicity (P-heterogeneity = .057); black women were more likely than white women to have a recurrence score of 26 or higher (HR, 1.38; 95% CI, 1.00-1.92). No significant difference was observed in the risks of subsequent IBC subtypes for Hispanic women. Conclusions Black and Asian women with DCIS had higher risks of developing biologically aggressive IBC than white counterparts. This should be considered in treatment decisions for black and Asian patients with DCIS.