PO.CL11.01 · 临床研究

Pathways乳腺癌幸存者研究中女性第二原发恶性肿瘤风险的种族/族裔差异

Racial/ethnic disparities in risk of second primary malignancy among women in the Pathways Study of breast cancer survivors

编号 5221 展板 12 时间 4/21 09:00–12:00 区域 Section 41 主讲 Pragati Advani, Dr PH;MD;MPH

分会场 Biological and Clinical Consequences of Cancer Therapy

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作者与单位 Authors & Affiliations

Pragati Gole Advani¹, Lia D’Addario², Cecile A. Laurent², Janise M. Roh², Marilyn L. Kwan³, Theresa H. Keegan⁴, Isaac J. Ergas², Scarlett L. Gomez⁵, Han Yu⁶, Christine B. Ambrosone⁷, Lawrence H. Kushi⁸

¹Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY,²Division of Research, Kaiser Permanente Northern California, Pleasanton, CA,³Research Scientist, Div. of Research, Kaiser Permanente Northern California, Oakland, CA,⁴Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA,⁵Department of Epidemiology and Biostatistics, University of California, San Francisco, CA,⁶Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY,⁷Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY,⁸Director of Scientific Policy, Division of Research, Kaiser Permanente, Oakland, CA

摘要 Abstract

中文摘要

背景：乳腺癌（BC）幸存者面临着发展第二原发恶性肿瘤（SPM）的显著增加风险。虽然癌症治疗的晚期效应促成了SPM风险，但导致初始BC的共有行为和遗传因素也可能影响SPM的发生。先前研究已报道BC发病率和死亡率存在显著的种族/族裔差异；然而，很少有研究检查BC后SPM风险的差异。本研究的目的是评估BC女性各种族和族裔群体的SPM风险。方法：我们在Pathways研究中检查了SPM风险，这是一项前瞻性队列研究，纳入了2006至2013年间在Kaiser Permanente北加州（KPNC）新诊断的4,504名浸润性BC女性。使用单变量Fine-Gray亚分布风险模型评估自我认定的种族/族裔（分类为非西班牙裔白人[白人]、非西班牙裔黑人[黑人]、非西班牙裔亚裔美国人/太平洋岛民[AAPI]和西班牙裔/拉丁裔[H/L]）与SPM之间的关联。模型调整了年龄、分期、分级、激素受体状态和治疗类型。由于数量较少，92名美洲印第安人/阿拉斯加原住民参与者被排除。随访从BC诊断日期至SPM、退出KPNC健康计划、死亡或2022年12月31日，以先到者为准。结果：在纳入研究的4,412名BC患者中，2,950名（66.9%）为白人，351名（8.0%）为黑人，599名（13.6%）为AAPI，512名（11.6%）为H/L。总体上，612名（13.6%）发展出SPM（中位随访时间=14.2年；范围=9.8-17.3）。在521名已知SPM部位的患者中，乳腺（197，37.8%）、生殖器官（74，14.2%）和肺（48，9.2%）是最常见的部位。在多变量分析中，我们发现与白人女性相比，H/L发展SPM的风险显著降低（风险比[HR]=0.64；95%置信区间[95%CI]=0.43-0.95）。虽然我们也观察到AAPI和黑人女性的SPM风险较低（HR分别为0.71，95%CI=0.49-1.02；和0.79，95%CI=0.51-1.22），但这些关联未达到统计学显著性。除种族/族裔外，BC诊断时的年龄也是SPM风险的显著预测因子。与<50岁诊断的女性相比，诊断时年龄较大（60-69岁和70岁以上）与SPM风险显著增加相关（HR60-69=1.66，95%CI=1.17-2.34；HR70+=2.37，95%CI=1.64-3.41）。结论：我们在KPNC BC幸存者队列中观察到SPM风险存在显著的种族/族裔差异，H/L患者的风险低于白人，而较大年龄组（60岁以上）的患者经历较高风险。有必要进一步研究这些种族、族裔和年龄相关异质性的驱动因素。考虑这些特征的定制化监测策略可能有助于减少BC幸存者之间的差异。

查看英文原文 English abstract

Background: Breast cancer (BC) survivors face a significantly increased risk of developing a second primary malignancy (SPM). While late-effects of cancer treatments contribute to SPM risk, shared behavioral and genetic factors that lead to the initial BC may also affect development of SPM. Previous studies have reported significant racial/ethnic disparities in BC incidence and mortality; however, few have examined disparities on the risk of SPM after BC. The aim of this study was to evaluate SPM risk across racial and ethnic groups of women with BC. Methods: We examined risk of SPM in the Pathways Study, a prospective cohort study of 4,504 women with newly diagnosed, invasive BC between the years 2006 and 2013, at Kaiser Permanente Northern California (KPNC). Associations between self-identified race/ethnicity (categorized as non-Hispanic White [White], non-Hispanic Black [Black], non-Hispanic Asian American/Pacific Islander [AAPI] and Hispanic/Latino [H/L]) and SPM was evaluated using a univariate Fine-Gray sub distribution hazard model. Models were adjusted for age, stage, grade, hormone receptor status and treatment type. Due to small numbers, 92 American Indian/Alaska Native participants were excluded. Follow-up was from date of BC diagnosis to SPM, disenrollment from the KPNC health plan, death, or December 31, 2022, whichever came first. Results: Of the 4,412 BC patients included in the study, 2,950 (66.9%) were White, 351 (8.0%) Black, 599 (13.6%) AAPI and 512 (11.6%) were H/L. Overall, 612 (13.6%) developed a SPM (median follow-up time=14.2 years; range=9.8-17.3). Among 521 patients with known SPM sites, breast (197, 37.8%), reproductive organs (74, 14.2%) and lung (48, 9.2%) were most common sites. In multivariable analyses, we found that compared with White women, H/L had a significantly decreased risk of developing a SPM (Hazard Ratio [HR]=0.64; 95% Confidence Interval [95%CI]=0.43-0.95). Although we also observed lower risk of SPM in AAPI and Black women (HRs of 0.71, 95%CI=0.49-1.02; and 0.79, 95%CI=0.51-1.22, respectively), these associations did not reach statistical significance. Besides race/ethnicity, age at BC diagnosis was also a significant predictor of SPM risk. Older age at diagnosis (60-69 and 70+ years) was associated with significantly increased SPM risk (HR 60-69 =1.66, 95% CI=1.17-2.34 and HR 70+ =2.37, 95% CI=1.64-3.41) compared with women diagnosed at <50 years. Conclusion: We observed substantial disparities in SPM risk by race/ethnicity in the KPNC BC survivor's cohort, with H/L patients experiencing lower risk than Whites, whereas those in the older age group (60+ years) experienced higher risks. Further research to understand drivers of these racial, ethnic and age-related heterogeneity is warranted. Tailored surveillance strategies accounting for these characteristics may help reduce disparities among BC survivors.

利益披露 Disclosure

P. G. Advani, None.. L. D’Addario, None.. C. A. Laurent, None.. J. M. Roh, None.. M. L. Kwan, None.. T. H. Keegan, None.. I. J. Ergas, None.. S. L. Gomez, None.. H. Yu, None.. C. B. Ambrosone, None.. L. H. Kushi, None.

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