Brandão Mariana, Guisseve Assucena, Bata Genoveva, Alberto Matos, Ferro Josefo, Garcia Carlos, Zaqueu Clésio, Lorenzoni Cesaltina, Leitão Dina, Come Jotamo, Soares Otília, Gudo-Morais Alberto, Schmitt Fernando, Tulsidás Satish, Carrilho Carla, Lunet Nuno
EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Academic Trials Promoting Team, Institut Jules Bordet, Bruxelles, Belgium.
Department of Pathology, Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique; Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
ESMO Open. 2020 Oct;5(5):e000829. doi: 10.1136/esmoopen-2020-000829.
BACKGROUND: Data regarding breast cancer epidemiology, treatment and survival in Africa are scarce. We aimed to assess the distribution of breast cancer subtypes in Mozambique and its impact on patients' treatment and survival. The concordance of biomarker assessment between cytological and histological samples was also evaluated. METHODS: Prospective cohort study including 210 patients diagnosed between January 2015 and August 2017, followed to November 2019. Clinicopathological characteristics, treatment, 3-year overall survival (OS) and disease-free survival (DFS) were compared across classic tumour subtypes (oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (St. Gallen classification). Concordance was measured using Cohen's κ statistics. RESULTS: A total of 51% of patients had ER-positive/HER2-negative tumours, 24% HER2-positive and 25% TNBC. Concordance between cytological and histological samples regarding ER and HER2 status was substantial (κ=0.762 and κ=0.603, respectively). There were no significant differences across subtypes regarding clinical characteristics and treatment, except for HIV positivity and high histological grade (more prevalent among TNBC) or endocrine therapy (higher use among ER-positive/HER2-negative and HER2-positive patients). Three-year OS was 52.5% (95% CI, 44.3% to 60.0%), being higher in ER-positive/HER2-negative (61.1%) compared with HER2-positive (53.2%) and TNBC (31.9%) patients. Adjusted HRs were 1.96 (95% CI, 1.13 to 3.39) among HER2-positive and 3.10 (95% CI, 1.81 to 5.31) among TNBC versus ER-positive/HER2-negative patients. Three-year DFS was 46.6% (95% CI, 38.0% to 54.8%), being lower among TNBC versus ER-positive/HER2-negative patients (HR 2.91; 95% CI, 1.64 to 5.16). Results were similar between surrogate intrinsic subtypes. CONCLUSION: There was a high proportion of HER2-positive and TNBC among Mozambican patients and their survival was poor compared with ER-positive/HER2-negative patients, partly due to the limited treatment options. A systematic assessment of ER, PR and HER2 status is feasible and may help tailoring and optimise the treatment of patients with breast cancer in low-resource settings, potentially leading to survival gains in this underserved population.
背景：关于非洲乳腺癌流行病学、治疗及生存情况的数据匮乏。我们旨在评估莫桑比克乳腺癌亚型的分布及其对患者治疗和生存的影响。同时还评估了细胞学和组织学样本中生物标志物评估的一致性。 方法：前瞻性队列研究，纳入2015年1月至2017年8月间确诊的210例患者，随访至2019年11月。比较经典肿瘤亚型（雌激素受体（ER）阳性/人表皮生长因子受体2（HER2）阴性、HER2阳性和三阴性乳腺癌（TNBC））及替代内在亚型（圣加仑分类）的临床病理特征、治疗、3年总生存（OS）和无病生存（DFS）情况。使用Cohen's κ统计量测量一致性。 结果：共有51%的患者为ER阳性/HER2阴性肿瘤，24%为HER2阳性，25%为TNBC。细胞学和组织学样本在ER和HER2状态方面的一致性较高（κ分别为0.762和0.603）。各亚型在临床特征和治疗方面无显著差异，但HIV阳性和高组织学分级（在TNBC中更常见）或内分泌治疗（在ER阳性/HER2阴性和HER2阳性患者中使用更多）除外。3年OS为52.5%（95%CI，44.3%至60.0%），ER阳性/HER2阴性患者（61.1%）高于HER2阳性患者（53.2%）和TNBC患者（31.9%）。与ER阳性/HER2阴性患者相比，HER2阳性患者的校正风险比为1.96（95%CI，1.13至3.39），TNBC患者为3.10（95%CI，1.81至5.31）。3年DFS为46.6%（95%CI，38.0%至54.8%），TNBC患者低于ER阳性/HER2阴性患者（风险比2.91；95%CI，1.64至5.16）。替代内在亚型之间的结果相似。 结论：莫桑比克患者中HER2阳性和TNBC比例较高，与ER阳性/HER2阴性患者相比，其生存情况较差，部分原因是治疗选择有限。对ER、PR和HER2状态进行系统评估是可行的，可能有助于在资源有限的环境中为乳腺癌患者量身定制并优化治疗，有望使这一服务不足人群的生存率提高。
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