Lin Xiaoyi, Lin Xin, Li Yingzi, Zhang Yuchen, Lin Jiali, Zhang Guochun
Department of Breast Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.
Shantou University Medical College, Shantou, Guangdong, People's Republic of China.
Int J Gen Med. 2021 Nov 24;14:8775-8784. doi: 10.2147/IJGM.S338455. eCollection 2021.
Our study aims to analyze the association between HER2 status of breast cancer (BC) and second primary malignancy (SPM) occurrence.
Based on BC patients registered between 2010 and 2018 in the NCI SEER database, we utilized standardized incidence ratio (SIR) and Poisson regression to quantify SPM occurrence compared with the general population. Then, adjusted for competing death risk, cumulative incidence function and Gray's test were adopted to estimate the probability of SPM. Subsequent proportional subdistribution hazards regression was executed to identify the HER2 status impact on SPM risk. Finally, survival analysis was performed.
A total of 409,796 first BC patients were included and 18,283 were identified with at least one SPM. The SIR of SPM after HER2+ BC was significantly lower than HER2- BC (1.03 vs 1.13; RR, 0.92; 95% CI, 0.88-0.96; p<0.001). The predominantly declining SPM risk was only observed for second BC (RR, 0.89; 95% CI, 0.82-0.96; p=0.003) and lung cancer (RR, 0.84; 95% CI, 0.74-0.95; p=0.007). Furthermore, competing risk analysis verified the protective effect of HER2 positivity status on SPM occurrence. The 5-year cumulative incidence of SPM following HER2+ and HER2- BC were 4.09% and 5.16%, respectively (p<0.001). In addition, among patients suffering from SPM, HER2 positivity status contributed to better overall survival.
It is demonstrated that HER2+ BC patients had lower SPM incidence, which was remarkable for second BC and lung cancer.
本研究旨在分析乳腺癌（BC）的HER2状态与第二原发性恶性肿瘤（SPM）发生之间的关联。
基于2010年至2018年在美国国立癌症研究所监测、流行病学和最终结果（NCI SEER）数据库中登记的BC患者，我们使用标准化发病比（SIR）和泊松回归来量化与一般人群相比SPM的发生情况。然后，在调整了竞争死亡风险后，采用累积发病率函数和格雷检验来估计SPM的概率。随后进行比例子分布风险回归以确定HER2状态对SPM风险的影响。最后，进行生存分析。
共纳入409,796例初发BC患者，其中18,283例被确定患有至少一种SPM。HER2阳性BC后SPM的SIR显著低于HER2阴性BC（1.03对1.13；风险比，0.92；95%置信区间，0.88 - 0.96；p<0.001）。仅在第二原发性BC（风险比，0.89；95%置信区间，0.82 - 0.96；p = 0.003）和肺癌（风险比，0.84；95%置信区间，0.74 - 0.95；p = 0.007）中观察到SPM风险主要呈下降趋势。此外，竞争风险分析证实了HER2阳性状态对SPM发生的保护作用。HER2阳性和HER2阴性BC后SPM的5年累积发病率分别为4.09%和5.16%（p<0.001）。此外，在患有SPM的患者中，HER2阳性状态有助于提高总体生存率。
结果表明，HER2阳性BC患者的SPM发病率较低，这在第二原发性BC和肺癌中尤为明显。
