Response to Treatment, Racial and Ethnic Disparity, and Survival in Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy in the US.
Response to Treatment, Racial and Ethnic Disparity, and Survival in Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy in the US.
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在美国接受新辅助化疗的乳腺癌患者的治疗，种族和种族差异以及乳腺癌患者的反应。
DOI：
10.1001/jamanetworkopen.2023.5834
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发表时间：
2023-03-01
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
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作者：
乳腺癌新辅助化疗的反应是否存在可能影响生存的种族和民族差异？在这项纳入107207例I至III期乳腺癌患者的队列研究中，观察到病理学完全缓解率存在显著的种族和民族差异。这些人种和种族差异是亚型特异性的，并被发现占确定的生存差异的很大一部分。这项研究的结果表明，生物标志物知情的最佳治疗可以改善治疗反应，反过来，最终可能减少生存结局的种族和民族差异。这项队列研究检查了不同种族和民族乳腺癌患者对新辅助化疗反应的差异。随着美国乳腺癌患者新辅助化疗（NACT）的增加，了解不同人种和种族对NACT的反应是否存在差异以及潜在的长期结局非常重要。检查NACT后病理学完全缓解（pCR）率是否存在任何种族和民族差异，如果存在，是否因分子亚型而异，并与生存期相关。回顾性队列研究，纳入2010年1月至2017年12月诊断为I期至III期乳腺癌，接受手术并接受NACT的患者;中位随访时间为5.8年，数据分析时间为2021年8月至2023年1月。数据来自国家癌症数据库，这是一个全国性的、基于机构的肿瘤学数据集，捕获了美国所有新诊断乳腺癌病例的约70%。病理完全缓解定义为ypT 0/Tis ypN 0，使用逻辑回归建模。使用Weibull加速失效时间模型分析生存率的种族和民族差异。进行中介分析，以衡量种族和民族差异的pCR率是否影响生存。该研究纳入了107207例患者（106587例[99.4%]女性），平均（SD）年龄为53.4（12.1）岁。共有5009例患者为亚裔或太平洋岛民，18417例为非西班牙裔黑人，9724例为西班牙裔，74057例为非西班牙裔白色人。pCR率存在显著的种族和民族差异，但差异具有亚型特异性。在激素受体阴性（HR−）/erb-b2受体酪氨酸激酶2（ERBB 2;以前称为HER 2或HER 2/neu）阳性（ERBB 2+）亚型中，亚洲和太平洋岛民患者的pCR率最高（56.8%），其次是西班牙裔（55.2%）和非西班牙裔白色（52.3%）患者，黑人患者的pCR率最低（44.8%）。在三阴性乳腺癌中，黑人患者的pCR率（27.3%）低于其他种族和民族（均>30%）。在HR+/ERBB 2 −亚型中，黑人患者的pCR率（11.3%）高于其他人种/种族组（均≤10%）。在中介分析中，NACT后实现pCR的种族和民族差异可以解释约20%至53%的种族和民族间亚型特异性生存差异。在这项接受NACT的乳腺癌患者队列研究中，黑人患者三阴性和HR−/ERBB 2+乳腺癌的pCR率较低，但HR+/ERBB 2 −疾病的pCR率较高，而亚裔和太平洋岛民患者HR−/ERBB 2+疾病的pCR率较高。肿瘤分级和ERBB 2拷贝数可以解释这些亚型内差异，但需要进一步研究。不能实现pCR可以部分介导，但不完全介导黑人患者经历的更差的生存结局。
Are there racial and ethnic differences in response to neoadjuvant chemotherapy of breast cancer that may have survival implications? In this cohort study of 107 207 patients with stage I to III breast cancer, significant racial and ethnic differences in pathologic complete response rates were observed. These racial and ethnic differences were subtype-specific and were found to account for a substantial portion of the identified survival disparity. The findings of this study suggest that biomarker-informed optimal treatment could improve treatment response, and in turn, may ultimately reduce racial and ethnic disparity in survival outcomes. This cohort study examines discrepancies in response to neoadjuvant chemotherapy among patients in differing racial and ethnic groups with breast cancer. With the increasing delivery of neoadjuvant chemotherapy (NACT) for patients with breast cancer in the US, it is important to know whether there is differential response to NACT by race and ethnicity and the potential long-term outcomes. To examine whether there were any racial and ethnic differences in pathologic complete response (pCR) rate following NACT and, if so, whether they varied by molecular subtype and were associated with survival. A retrospective cohort study was conducted including patients with stage I to III breast cancer diagnosed between January 2010 and December 2017 who underwent surgery and received NACT; median follow-up was 5.8 years, and data analysis was conducted from August 2021 to January 2023. Data were obtained from the National Cancer Data Base, a nationwide, facility-based, oncology data set that captures approximately 70% of all newly diagnosed cases of breast cancer in the US. Pathologic complete response, defined as ypT0/Tis ypN0, was modeled using logistic regression. Racial and ethnic differences in survival were analyzed using a Weibull accelerated failure time model. Mediation analysis was conducted to measure whether racial and ethnic differences in the pCR rate affect survival. The study included 107 207 patients (106 587 [99.4%] women), with a mean (SD) age of 53.4 (12.1) years. A total of 5009 patients were Asian or Pacific Islander, 18 417 were non-Hispanic Black, 9724 were Hispanic, and 74 057 were non-Hispanic White. There were significant racial and ethnic differences in pCR rates, but the differences were subtype-specific. In hormone receptor–negative (HR−)/erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)–positive (ERBB2+) subtype, Asian and Pacific Islander patients achieved the highest pCR rate (56.8%), followed by Hispanic (55.2%) and non-Hispanic White (52.3%) patients with the lowest pCR rate seen in Black patients (44.8%). In triple-negative breast cancer, Black patients had a lower pCR rate (27.3%) than other racial and ethnic groups (all >30%). In HR+/ERBB2− subtype, Black patients had a higher pCR rate (11.3%) than other racial/ethnic groups (all ≤10%). In mediation analysis, racial and ethnic differences in achieving pCR after NACT could explain approximately 20% to 53% of the subtype-specific survival differences across racial and ethnic groups. In this cohort study of patients with breast cancer receiving NACT, Black patients had a lower pCR rate for triple-negative and HR−/ERBB2+ breast cancer but a higher pCR rate for HR+/ERBB2− diseases, whereas Asian and Pacific Islander patients had a higher pCR rate for HR−/ERBB2+ diseases. Tumor grade and ERBB2 copy number could account for some of these within-subtype disparities, but further studies are warranted. Inability to achieve a pCR can mediate in part, but not entirely, the worse survival outcomes experienced by Black patients.
DOI：
10.7759/cureus.16127
发表时间：
2021-07
期刊：
Cureus
影响因子：
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作者：
Ho Y;Harris A;Wesolowski M;Refaat T;Small W Jr;Thomas TO
通讯作者：
Thomas TO
影响因子：
3.7
作者：
Relation T;Obeng-Gyasi S;Bhattacharyya O;Li Y;Eskander MF;Tsung A;Oppong BA
通讯作者：
Oppong BA