种族/民族差异与三阴性乳腺癌新辅助化疗患者病理完全缓解和总生存的关系。
Racial/Ethnic Disparities in Pathologic Complete Response and Overall Survival in Patients With Triple-Negative Breast Cancer Treated With Neoadjuvant Chemotherapy.
机构信息
Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC.
Duke Cancer Institute, Durham, NC.
出版信息
J Clin Oncol. 2024 May 10;42(14):1635-1645. doi: 10.1200/JCO.23.01199. Epub 2024 Feb 23.
PURPOSE
Black women have higher rates of death from triple-negative breast cancer (TNBC) than White women. We hypothesized that pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) and overall survival (OS) may vary by race/ethnicity in patients with TNBC.
METHODS
We identified women 18 years and older with stage I-III TNBC who received NAC followed by surgery from the National Cancer Database (2010-2019). We excluded patients without race/ethnicity or pathology data. Primary outcomes were pCR rates and OS on the basis of race/ethnicity.
RESULTS
Forty thousand eight hundred ninety women with TNBC met inclusion criteria (median age [IQR], 53 [44-61] years): 26,150 Non-Hispanic White (64%, NHW), 9,672 Non-Hispanic Black (23.7%, NHB), 3,267 Hispanic (8%), 1,368 Non-Hispanic Asian (3.3%, NHA), and 433 Non-Hispanic Other (1.1%, NHO) patients. Overall, 29.8% demonstrated pCR (NHW: 30.5%, NHB: 27%, Hispanic: 32.6%, NHA: 28.8%, NHO: 29.8%). Unadjusted OS was significantly higher for those with pCR compared with those with residual disease (5-year OS, 0.917 [95% CI, 0.911 to 0.923] 0.667 [95% CI, 0.661 to 0.673], log-rank < .001), and this association persisted after adjustment for demographic and tumor factors. The effect of achieving pCR on OS did not differ by race/ethnicity (interaction = .10). However, NHB patients were less likely (odds ratio [OR], 0.89 [95% CI, 0.83 to 0.95], = .001) and Hispanic patients were more likely (OR, 1.19 [95% CI, 1.08 to 1.31], = .001) to achieve pCR than NHW patients. After adjustment for patient and disease factors, including achievement of pCR, Hispanic (hazard ratio [HR], 0.76 [95% CI, 0.69 to 0.85], < .001) and NHA (HR, 0.64 [95% CI, 0.55 to 0.75], < .001) race/ethnicity remained associated with OS.
CONCLUSION
Odds of achieving pCR and OS in patients with TNBC appear to be associated with race/ethnicity. Additional research is necessary to understand how race/ethnicity is associated with rates of pCR and OS, whether related to socioeconomic factors or biologic variables, or both.
目的
黑人女性死于三阴性乳腺癌（TNBC）的比率高于白人女性。我们假设，在 TNBC 患者中，新辅助化疗（NAC）后的病理完全缓解（pCR）和总生存期（OS）可能因种族/民族而异。
方法
我们从国家癌症数据库（2010-2019 年）中确定了接受 NAC 后接受手术治疗的 18 岁及以上 I-III 期 TNBC 女性。我们排除了没有种族/民族或病理数据的患者。主要结局是基于种族/民族的 pCR 率和 OS。
结果
符合纳入标准的 4890 名 TNBC 女性（中位年龄[IQR]，53[44-61]岁）：26150 名非西班牙裔白人（NHW，64%），9672 名非西班牙裔黑人（NHB，23.7%），3267 名西班牙裔（8%），1368 名非西班牙裔亚裔（3.3%，NHA）和 433 名非西班牙裔其他种族（1.1%，NHO）患者。总体而言，29.8%的患者表现出 pCR（NHW：30.5%，NHB：27%，西班牙裔：32.6%，NHA：28.8%，NHO：29.8%）。与残留疾病相比，pCR 患者的未调整 OS 显著更高（5 年 OS，0.917[95%CI，0.911 至 0.923]与 0.667[95%CI，0.661 至 0.673]，对数秩 <.001），并且这种关联在调整人口统计学和肿瘤因素后仍然存在。实现 pCR 对 OS 的影响不因种族/民族而异（交互作用=0.10）。然而，与 NHW 患者相比，NHB 患者（比值比[OR]，0.89[95%CI，0.83 至 0.95]， =.001）不太可能，而西班牙裔患者（OR，1.19[95%CI，1.08 至 1.31]， =.001）更有可能实现 pCR。在调整患者和疾病因素（包括实现 pCR）后，西班牙裔（风险比[HR]，0.76[95%CI，0.69 至 0.85]， <.001）和 NHA（HR，0.64[95%CI，0.55 至 0.75]， <.001）种族/民族与 OS 仍然相关。
结论
在 TNBC 患者中，实现 pCR 和 OS 的可能性似乎与种族/民族有关。需要进一步研究以了解种族/民族与 pCR 和 OS 率的关系，是与社会经济因素还是生物学变量有关，还是两者都有关。
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