Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA.
Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, USA.
Ann Surg Oncol. 2024 Oct;31(11):7511-7519. doi: 10.1245/s10434-024-15707-w. Epub 2024 Jul 16.
Many adolescent and young adult (AYA) patients with breast cancer (BC) receive adjuvant therapy as initial treatment, with long-term bone marrow suppression as a potential complication, but no studies have evaluated the impact of race/ethnicity on the development of bone marrow suppression in AYA BC survivors.
Female patients ages 15-39 years diagnosed with BC (2006-2018) and surviving ≥ 2 years were identified from the California Cancer Registry and linked to statewide hospitalization data. We estimated the cumulative incidence of developing late effects of bone marrow suppression, such as leukopenia, anemia, thrombocytopenia, bleeding, and infection/sepsis, during hospital discharge diagnoses present ≥ 2 years after diagnosis. We examined the impact of sociodemographic and clinical factors on late effects using multivariate Cox proportional hazards regression.
Of 11,293 patients, 42.8% were non-Hispanic (nH) White, 28.8% Hispanic, 19.5% nH Asian/Pacific Islander, and 7.5% nH Black. In multivariable analyses, nH Blacks had the highest risk (versus nH Whites) of anemia [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.47-2.02], leukopenia (HR 1.56, CI 1.14-2.13), thrombocytopenia (HR 1.46, CI 1.08-1.99), major infection/sepsis (HR 1.64, CI 1.4-1.92), and bleeding (HR 1.89, CI 1.39-2.58). Hispanics had a higher risk of developing anemia (HR 1.17, CI 1.04-1.32), bleeding (HR 1.4, CI 1.12-1.76), and major infections/sepsis (HR 1.36, CI 1.21-1.52). Asian/Pacific Islanders had only a higher risk of developing bleeding (HR 1.33, CI 1.03-1.72). Patients from a low neighborhood socioeconomic status had a 20% higher risk of infection/sepsis (HR 1.21, CI 1.1-1.34), but there were no associations for the other late effects.
We identified that AYAs of nH Black, Hispanic, and Asian/Pacific Islander race/ethnicity are at an increased risk of several late effects after adjuvant therapy compared with nH White patients. From these data, providers can implement early/frequent screening of hematologic late effects in these high-risk survivors.
许多青少年和年轻成年（AYA）乳腺癌（BC）患者接受辅助治疗作为初始治疗，长期骨髓抑制是潜在的并发症，但没有研究评估种族/民族对 AYA BC 幸存者骨髓抑制发展的影响。
从加利福尼亚癌症登记处确定了 2006 年至 2018 年期间诊断为 BC 且存活时间≥2 年的 15-39 岁女性患者，并与全州住院数据相关联。我们估计了在诊断后≥2 年的出院诊断中出现骨髓抑制的迟发性效应（如白细胞减少症、贫血、血小板减少症、出血和感染/败血症）的累积发生率。我们使用多变量 Cox 比例风险回归分析检查了社会人口统计学和临床因素对迟发性效应的影响。
在 11293 名患者中，42.8%是非西班牙裔（nH）白人，28.8%为西班牙裔，19.5%为 nH 亚裔/太平洋岛民，7.5%为 nH 黑人。在多变量分析中，nH 黑人发生贫血（风险比[HR] 1.72，95%置信区间[CI] 1.47-2.02）、白细胞减少症（HR 1.56，CI 1.14-2.13）、血小板减少症（HR 1.46，CI 1.08-1.99）、严重感染/败血症（HR 1.64，CI 1.4-1.92）和出血（HR 1.89，CI 1.39-2.58）的风险最高（与 nH 白人相比）。西班牙裔患者发生贫血（HR 1.17，CI 1.04-1.32）、出血（HR 1.4，CI 1.12-1.76）和严重感染/败血症（HR 1.36，CI 1.21-1.52）的风险较高。亚裔/太平洋岛民仅发生出血的风险较高（HR 1.33，CI 1.03-1.72）。来自低邻里社会经济地位的患者发生感染/败血症的风险增加了 20%（HR 1.21，CI 1.1-1.34），但其他迟发性效应没有关联。
我们发现与 nH 白人患者相比，nH 黑人、西班牙裔和亚裔/太平洋岛民种族/民族的 AYA 患者在接受辅助治疗后发生多种迟发性效应的风险增加。根据这些数据，医务人员可以对这些高危幸存者进行早期/频繁的血液学迟发性效应筛查。
