Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute at Mount Sinai, New York, NY, USA.
, Bakersfield, CA, USA.
Ann Surg Oncol. 2021 Oct;28(11):5941-5947. doi: 10.1245/s10434-021-09748-8. Epub 2021 Apr 3.
Black women with breast cancer have a worse overall survival compared with White women; however, no difference in Oncotype DX™ (ODX) recurrence scores has been observed to explain this health disparity. Black women are also disproportionately affected by insulin resistance. We evaluated whether insulin resistance is associated with a higher ODX recurrence score and whether there is a difference between White and Black women to explain disparate clinical outcomes.
A subgroup analysis of patients in a multi-institutional cross-sectional study evaluating differences in insulin resistance between White and Black women was performed. Women diagnosed with a new hormone receptor-positive, HER2/neu-negative breast cancer with an ODX recurrence score were identified. Fasting blood glucose and insulin measurements were used to calculate the homeostatic model assessment of insulin resistance (HOMA-IR) score, a method for assessing insulin resistance, and compared against ODX scores.
Overall, 412 women (358 White women, 54 Black women) were identified. Compared with White women, Black women had a higher body mass index (30 vs. 26 kg/m, p < 0.0001), higher HOMA-IR score (2.4 vs. 1.4, p = 0.004), and more high-grade tumors (30% vs. 16%, p = 0.01). There was a direct positive association with an increasing ODX score and HOMA-IR (p = 0.014). On subset analysis, this relationship was seen in White women (p = 0.005), but not in Black women (p = 0.55).
In women with newly diagnosed breast cancer, increasing insulin resistance is associated with a higher recurrence score; however, this association was not present in Black women. This lack of association may be due to the small number of Black women in the cohort, or possibly a reflection of a different biological disease process of the patient's tumor.
与白人女性相比，患有乳腺癌的黑人女性总体生存率更差；然而，并未观察到 Oncotype DX（ODX）复发评分的差异可以解释这种健康差异。黑人女性也不成比例地受到胰岛素抵抗的影响。我们评估了胰岛素抵抗是否与更高的 ODX 复发评分相关，以及白人和黑人女性之间是否存在差异可以解释不同的临床结果。
对一项评估白人和黑人女性之间胰岛素抵抗差异的多机构横断面研究中的患者进行了亚组分析。确定了新诊断为激素受体阳性、HER2/neu 阴性乳腺癌且 ODX 复发评分的女性。测量空腹血糖和胰岛素，以计算用于评估胰岛素抵抗的稳态模型评估的胰岛素抵抗（HOMA-IR）评分，并与 ODX 评分进行比较。
总共确定了 412 名女性（358 名白人女性，54 名黑人女性）。与白人女性相比，黑人女性的体重指数更高（30 比 26kg/m2，p<0.0001）、HOMA-IR 评分更高（2.4 比 1.4，p=0.004）和更多的高级别肿瘤（30%比 16%，p=0.01）。ODX 评分与 HOMA-IR 呈直接正相关（p=0.014）。在亚组分析中，这种关系在白人女性中可见（p=0.005），但在黑人女性中不可见（p=0.55）。
在新诊断为乳腺癌的女性中，胰岛素抵抗的增加与更高的复发评分相关；然而，这种关联在黑人女性中不存在。这种关联的缺失可能是由于队列中黑人女性的数量较少，或者可能反映了患者肿瘤的不同生物学疾病过程。
