Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC.
Duke Cancer Institute, Durham, NC.
J Clin Oncol. 2024 May 10;42(14):1635-1645. doi: 10.1200/JCO.23.01199. Epub 2024 Feb 23.
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.
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.
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.
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.
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。
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。
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。
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。
