LBPO.PS01 · 人群科学 · Late-Breaking

美国HIV感染者中按分子亚型划分的乳腺癌风险

Breast cancer risk according to molecular subtype among people living with HIV in the United States

编号 LB383 展板 13 时间 4/21 02:00–05:00 区域 Section 55 主讲 Kaitlin White, BS

分会场 Late-Breaking Research: Population Sciences

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作者与单位 Authors & Affiliations

Kaitlin White¹, Qianlai Luo¹, Ruth Pfieffer¹, Eric Engels¹, Meredith Shiels¹, Karen Pawlish², Analise Monterosso³, Jennifer Hayes⁴, Jonine Figueroa¹, Cameron Haas¹

¹National Cancer Inst. Div. of Cancer Epidemiology & Genetics, Bethesda, MD,²New Jersey Department of Health, Trenton, NJ,³Texas Department of State Health Services, Austin, TX,⁴Maryland Department of Health, Annapolis, MD

摘要 Abstract

中文摘要

背景：乳腺癌（BC）是HIV感染女性（WLWH）中最常见的非艾滋病定义性癌症（NADC），但其发病率低于与普通人群相比的预期。本分析研究了WLWH中乳腺癌的亚型特异性趋势。方法：我们分析了来自SEER和NPCR癌症登记处以及12个州、华盛顿特区和波多黎各的HIV监测系统的链接数据（2010-2019年）。我们识别了按雌激素受体（ER）和HER2状态、大小和分级分类的原位和浸润性BC病例。我们估计了标准化至2010年WLWH年龄分布的发病率、使用泊松回归的率的平均年度百分比变化（AAPC）以及标准化发病比（SIR，即观察病例数除以基于普通人群发病率的预期病例数，并考虑年龄、种族/民族、年份和登记处）。肿瘤大小分类为小（<2 cm）、中（2-4.9 cm）和大（>5 cm）。结果：在HIV感染的BC病例中，有286例原位和1120例浸润性BC病例，其中676例为ER+，379例为ER-。在ER-病例中，约68.9%（261例）为三阴性，20.1%（76例）为HER2富集型。AAPC显示WLWH各亚型BC发病率无变化。与普通人群相比，WLWH的浸润性BC总体风险降低33%（SIR= 0.67，95% CI 0.63-0.71），包括ER+ BC发病率降低43%（SIR= 0.57，95% CI 0.53-0.61）以及ER- BC发病率降低7%（SIR= 0.93，95% CI 0.84-1.03）（SIR ER+对SIR ER-异质性p>0.001），后者无统计学意义。HER2富集型和三阴性肿瘤的风险降低相似，分别为15%（SIR= 0.85，95% CI 0.67-1.06）和4%（SIR= 0.96，95% CI 0.84-1.08）。WLWH的原位BC率与普通人群相比风险降低38%（SIR= 0.62，95% CI 0.55-0.69）。总体而言，SIR在2010-2019年期间保持一致。在肿瘤大小和分级方面，WLWH的发病率均较普通人群降低。降低在小型（SIR= 0.66，95% 0.59-0.73）和中型肿瘤（SIR= 0.65，95% 0.57-0.73）中最为明显，而大型肿瘤发病率降低20%（SIR= 0.80，95% 0.66-0.98）。低级别和中级别肿瘤（1级和2级）分别显示46%（SIR= 0.54，95% CI 0.45-0.65）和45%（SIR= 0.55，95% CI 0.49-0.61）的风险降低，而3级肿瘤显示较小但仍显著的风险降低（SIR=0.70，95% CI 0.67-0.80）。结论：虽然WLWH的BC总体相对风险低于普通人群，但ER+肿瘤的风险降低显著大于ER-肿瘤。较小和原位肿瘤的较低风险也可能表明WLWH的筛查参与度较低。阐明免疫功能低下人群（包括WLWH）中BC风险降低的潜在因素，可能为WLWH和普通人群的预防和治疗策略提供参考。

查看英文原文 English abstract

Background: Breast cancer (BC) is the most common non-AIDS-defined cancer (NADCs) among women living with HIV (WLWH), yet incidence rates are lower than expected compared to the general population. This analysis investigates subtype-specific trends of breast cancer in WLWH. Methods: We analyzed linked data from SEER and NPCR cancer registries and HIV surveillance systems from 12 states, Washington, D.C., and Puerto Rico (2010-2019). We identified in situ and invasive BC cases classified by estrogen receptor (ER) and HER2 status, size, and grade. We estimated incidence rates standardized to the 2010 age distribution of WLWH, average annual percentage changes (AAPCs) in rates using Poisson regression and standardized incidence ratios (SIR) as observed number of cases divided by expected based on incidence in the general population, accounting for age, race/ethnicity, year, and registry. Tumor sizes were categorized as small (<2 cm), medium (2-4.9 cm), and large (>5 cm). Results: Among BC cases with HIV, there were 286 in situ and 1120 invasive BC cases of which 676 were ER+ and 379 were ER-. Of the ER- cases, about 68.9% (261 cases) were triple-negative and 20.1% (76 cases) were HER2-enriched. AAPCs showed no changes in incidence rates of BC for WLWH across all subtypes. Compared to the general population, WLWH demonstrated a 33% (SIR= 0.67, 95% CI 0.63-0.71) lower risk of invasive BC overall, including a 43% (SIR= 0.57, 95% CI 0.53-0.61) reduction in ER+ BC incidence and statistically non-significant 7% (SIR= 0.93, 95% CI 0.84-1.03) (SIR ER+ vs. SIR ER- p heterogeneity >0.001) reduction in ER- BC incidence. HER2-enriched and triple-negative tumors had similar reductions in risk, 15% (SIR= 0.85, 95% CI 0.67-1.06) and 4% (SIR= 0.96, 95% CI 0.84-1.08) respectively. WLWH in situ BC rates had a 38% (SIR= 0.62, 95% CI 0.55-0.69) lower risk compared to the general population. Overall, SIRs were consistent throughout the 2010-2019 period. Across tumor size and grade, WLWH have reduced incidence compared to the general population. Reductions were most pronounced for small (SIR= 0.66, 95% 0.59-0.73) and medium-sized tumors (SIR= 0.65, 95% 0.57-0.73) while large tumors had 20% (SIR= 0.80, 95% 0.66-0.98) decreased incidence. Low- and intermediate-grade tumors (Grade 1 and 2) showed 46% (SIR= 0.54, 95% CI 0.45-0.65) and 45% (SIR= 0.55, 95% CI 0.49-0.61) reductions in risk while Grade 3 tumors showed a smaller, but still significant reduction in risk (SIR=0.70, 95% CI 0.67-0.80). Conclusion: While relative risk for BC overall is lower for WLWH compared to the general population, the reduction in risk is significantly greater for ER+ tumors than ER- tumors. The lower risk in smaller and in situ tumors may also demonstrate less screening participation among WLWH. Clarifying factors underlying reduced BC risk in immunocompromised populations, including WLWH, may inform prevention and treatment strategies for WLWH and the general population.

利益披露 Disclosure

K. White, None.. Q. Luo, None.. R. Pfieffer, None.. E. Engels, None.. M. Shiels, None.. K. Pawlish, None.. A. Monterosso, None.. J. Hayes, None.. J. Figueroa, None.. C. Haas, None.

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