University at Buffalo, The State University of New York, 12 Capen Hall, Buffalo, NY, 14260, USA.
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY, 14203, USA.
BMC Cancer. 2024 Apr 13;24(1):461. doi: 10.1186/s12885-024-12238-1.
Despite numerous studies on racial/ethnic disparities among patients with breast cancer, there is a paucity of literature evaluating racial/ethnic differences in 21-gene recurrence score (RS) and survival differences stratified by RS risk categories. We thus performed an observational cohort study to examine racial/ethnic disparities in the context of RS.
The National Cancer Database (NCDB) was queried for female patients diagnosed between 2006 and 2018 with estrogen receptor (ER)-positive, pT1-3N0-1aM0 breast cancer who received surgery followed by adjuvant endocrine therapy and had RS data available. Logistic multivariable analysis (MVA) was built to evaluate variables associated with RS ≥ 26. Cox MVA was used to evaluate OS. Subgroup analyses were performed to compare the magnitude of racial/ethnic differences stratified by RS. P values less than 0.017 were considered statistically significant based on Bonferroni correction.
A total of 140,133 women were included for analysis. Of these, 115,651 (82.5%), 8,213 (5.9%), 10,814 (7.7%), and 5,455 (3.9%) were NHW, Hispanic, Black, and API women, respectively. Median (IQR) follow up was 66.2 months (48.0-89.8). Logistic MVA showed that, compared with NHW women, Black women were associated with higher RS (≥ 26 vs < 26: adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12-1.26, p < 0.001), while HW (aOR 0.93, 95% CI 0.86-1.00, p = 0.04) and API women (aOR 1.03, 95% CI 0.95-1.13, p = 0.45) were not. Cox MVA showed that, compared with NHW women, Black women had worse OS (adjusted hazards ratio [aHR] 1.10, 95% CI 1.02-1.19, p = 0.012), while HW (aHR 0.85, 95% CI 0.77-0.94, p = 0.001) and API (aHR 0.66, 95% CI 0.56-0.77, p < 0.001) women had better OS. In subgroup analysis, similar findings were noted among those with RS < 26, while only API women were associated with improved OS among others with RS ≥ 26.
To our knowledge, this is the largest study using nationwide oncology database to suggest that Black women were associated with higher RS, while HW and API women were not. It also suggested that Black women were associated with worse OS among those with RS < 26, while API women were associated with improved OS regardless of RS when compared to NHW women.
尽管有许多关于乳腺癌患者的种族/民族差异的研究，但评估种族/民族在 21 基因复发评分（RS）和按 RS 风险类别分层的生存差异方面的文献却很少。因此，我们进行了一项观察性队列研究，以检查 RS 背景下的种族/民族差异。
从国家癌症数据库（NCDB）中检索了 2006 年至 2018 年间诊断为雌激素受体（ER）阳性、pT1-3N0-1aM0 乳腺癌、接受手术并接受辅助内分泌治疗且具有 RS 数据的女性患者。使用逻辑多变量分析（MVA）来评估与 RS≥26 相关的变量。使用 Cox MVA 来评估 OS。进行亚组分析以比较按 RS 分层的种族/民族差异的程度。基于 Bonferroni 校正，P 值小于 0.017 被认为具有统计学意义。
共有 140133 名女性纳入分析。其中，115651（82.5%）、8213（5.9%）、10814（7.7%）和 5455（3.9%）分别为 NHW、西班牙裔、黑人和 API 女性。中位（IQR）随访时间为 66.2 个月（48.0-89.8）。逻辑 MVA 显示，与 NHW 女性相比，黑种人女性与更高的 RS（≥26 比<26：调整优势比[aOR]1.19，95%置信区间[CI]1.12-1.26，p<0.001）相关，而 HW（aOR 0.93，95%CI 0.86-1.00，p=0.04）和 API 女性（aOR 1.03，95%CI 0.95-1.13，p=0.45）则不然。Cox MVA 显示，与 NHW 女性相比，黑种人女性的 OS 较差（调整后的危险比[aHR]1.10，95%CI 1.02-1.19，p=0.012），而 HW（aHR 0.85，95%CI 0.77-0.94，p=0.001）和 API（aHR 0.66，95%CI 0.56-0.77，p<0.001）女性的 OS 较好。在亚组分析中，在 RS<26 的人群中也观察到了类似的发现，而只有 API 女性在 RS≥26 的人群中与改善的 OS 相关。
据我们所知，这是使用全国肿瘤数据库进行的最大规模研究，表明黑种人女性与更高的 RS 相关，而 HW 和 API 女性则不然。它还表明，在 RS<26 的人群中，黑种人女性与较差的 OS 相关，而无论 RS 如何，API 女性与 NHW 女性相比，OS 均有改善。
