Department of Hematology and Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
JAMA Netw Open. 2023 Nov 1;6(11):e2344517. doi: 10.1001/jamanetworkopen.2023.44517.
It remains unclear what survival benefit is associated with preoperative chemosensitivity after receiving neoadjuvant chemotherapy (NACT) among patients with resectable breast cancer from diverse racial and ethnic backgrounds.
To investigate racial and ethnic disparities in chemosensitivity and association with survival in patients with early-stage breast cancer.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study queried data from the National Cancer Database (NCDB) between calendar years 2010 and 2018. Participants included patients with breast cancer with clinical stage I to III disease treated with NACT. Preoperative chemosensitivity was defined as very sensitive (ypT0N0), sensitive (pathologic TNM stage less than clinical stage, excluding ypT0N0), and refractory (pathologic stage greater than or equal to clinical stage). Data were analyzed in November 2022.
Receipt of NACT and clinicopathologic and treatment factors contributing to racial and ethnic disparities in survival.
Overall survival of patients from diverse racial and ethnic backgrounds who received NACT.
This study included 103 605 patients (median age, 53 [IQR, 44-62] years, 99.5% [n = 103 060] women, and 68.7% [n = 71 203] White race). Among them, breast cancer was refractory in 43.2% (n = 44 796), sensitive in 34.4% (n = 35 638), and very sensitive in 22.4% (n = 23 171) of patients. In the hormone receptor-positive ERBB2 negative (formerly HER2 negative) group, patients had more refractory disease regardless of race or ethnicity (all races and ethnicities refractory: 54%-59%; P < .001). Among ERBB2 positive disease, Black patients had a lower percentage of very sensitive disease (32% vs 37%-40%; P < .001) and among triple-negative breast cancer, more refractory disease was seen among Black patients compared with other races and ethnicities (38% vs 30%-35%; P < .001). In refractory (hazard ratio [HR], 1.53; 95% CI, 1.47-1.60; P < .001) and sensitive (HR, 1.25; 95% CI, 1.17-1.33; P < .001) disease, Black patients had a higher mortality risk compared with White patients in the overall cohort. Asian patients had a lower mortality risk compared with White patients in refractory (HR, 0.71; 95% CI, 0.63-0.80; P < .001), sensitive (HR, 0.58; 95% CI, 0.49-0.69; P < .001), and very sensitive (HR, 0.60; 95% CI, 0.43-0.82; P < .001) disease groups in the overall cohort.
In this cohort study, Black patients had a higher mortality risk compared with White patients among those with residual disease after NACT. This highlights the need for personalized treatment strategies for Black patients to help them attain pathologic complete response.
重要性：对于接受新辅助化疗 (NACT) 后具有可切除乳腺癌的来自不同种族和族裔背景的患者，术前化疗敏感性与生存相关的获益仍不清楚。
目的：研究早期乳腺癌患者化疗敏感性的种族和族裔差异及其与生存的关联。
设计、地点和参与者：这是一项回顾性队列研究，从 2010 年至 2018 年期间的国家癌症数据库 (NCDB) 中查询数据。参与者包括接受 NACT 治疗的临床 I 期至 III 期疾病的乳腺癌患者。术前化疗敏感性定义为非常敏感 (ypT0N0)、敏感 (病理 TNM 分期低于临床分期，不包括 ypT0N0) 和耐药 (病理分期等于或大于临床分期)。数据分析于 2022 年 11 月进行。
暴露：接受 NACT 以及导致生存种族和族裔差异的临床病理和治疗因素。
主要结果和测量：接受 NACT 的来自不同种族和族裔背景的患者的总生存情况。
结果：这项研究包括 103605 名患者（中位年龄 53 [IQR，44-62] 岁，99.5%[n=103060] 为女性，68.7%[n=71203] 为白种人）。其中，43.2%（n=44796）的乳腺癌耐药，34.4%（n=35638）敏感，22.4%（n=23171）非常敏感。在激素受体阳性 ERBB2 阴性（以前称为 HER2 阴性）组中，无论种族或族裔如何，患者的耐药性疾病更多（所有种族和族裔耐药：54%-59%；P<0.001）。在 ERBB2 阳性疾病中，黑人患者的非常敏感疾病比例较低（32%比 37%-40%；P<0.001），而在三阴性乳腺癌中，黑人患者的耐药性疾病比例高于其他种族和族裔（38%比 30%-35%；P<0.001）。在耐药性疾病（危险比 [HR]，1.53；95%CI，1.47-1.60；P<0.001）和敏感性疾病（HR，1.25；95%CI，1.17-1.33；P<0.001）中，与白人患者相比，黑人患者的死亡率风险更高。与白人患者相比，亚洲患者在整个队列中耐药性（HR，0.71；95%CI，0.63-0.80；P<0.001）、敏感性（HR，0.58；95%CI，0.49-0.69；P<0.001）和非常敏感（HR，0.60；95%CI，0.43-0.82；P<0.001）疾病组中的死亡率风险更低。
结论和相关性：在这项队列研究中，与白人患者相比，黑人患者在接受 NACT 后仍有残留疾病的患者中死亡风险更高。这突显了为黑人患者制定个性化治疗策略的必要性，以帮助他们达到病理完全缓解。
