乳腺导管原位癌后浸润癌发生风险

　　既往研究发现，黑人女性与白人女性相比，普通人群的雌孕激素受体双阴性乳腺癌发生风险较高。不过，确诊乳腺导管原位癌之后，乳腺侵袭性浸润癌（特征为雌孕激素受体均为阴性或21基因复发评分较高）发生风险的种族差异尚不明确。

　　2019年5月23日，美国癌症学会《癌症》在线发表圣路易斯华盛顿大学巴恩斯犹太医院阿尔文塞特曼癌症中心、斯坦福大学医学院的研究报告，分析了乳腺导管原位癌之后乳腺侵袭性浸润癌的发生风险和种族差异。

　　该研究从美国国家癌症研究所（NCI）监测流行病学最终结果（SEER）数据库确定1990～2015年163892例乳腺导管原位癌女性，其中黑人10.5%、亚裔9.8%、西班牙裔8.6%。通过多因素比例风险回归模型，根据激素受体状态和21基因复发评分，推算随后发生乳腺浸润癌的风险比。

　　结果，中位随访90个月期间，发生乳腺浸润癌8333例。根据多因素比例风险回归模型对其他影响因素进行校正后，与白人女性相比，雌孕激素受体双阴性乳腺浸润癌发生风险：

• 黑人女性：高1.86倍（95%置信区间：1.57～2.20，10年相差2.2%）

• 亚裔女性：高1.40倍（95%置信区间：1.14～1.71，10年相差0.4%）

• 显著高于雌孕激素受体阳性乳腺癌（异质性P=0.0004）

　　随后发生早期雌激素受体阳性乳腺浸润癌的21基因复发评分随种族而不同（异质性P=0.057），与白人女性相比，复发评分≥26分的比例：

• 黑人女性：高1.38倍（95%置信区间：1.00～1.92）

• 亚裔女性：高1.11倍（95%置信区间：0.78～1.57）

　　西班牙裔女性与白人女性相比，随后发生各种亚型乳腺浸润癌的风险无显著差异。

　　因此，该研究结果表明，乳腺导管原位癌的黑人和亚裔女性随后发生侵袭性乳腺浸润癌的风险高于白人女性，对于黑人和亚裔乳腺导管原位癌患者的治疗决策应该考虑这个问题。

Cancer. 2019 May 23. [Epub ahead of print]

Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ.

Liu Y, West R, Weber JD, Colditz GA.

Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University, St. Louis, Missouri; Stanford University School of Medicine Stanford California.

Black and Asian women with ductal carcinoma in situ have a higher risk of developing biologically aggressive invasive breast cancer in comparison with white counterparts. This should be considered in treatment decisions for black and Asian patients with ductal carcinoma in situ.

BACKGROUND: General populations of black women have a higher risk of developing breast cancer negative for both estrogen receptor (ER) and progesterone receptor (PR) in comparison with white counterparts. Racial differences remain unknown in the risk of developing aggressive invasive breast cancer (IBC) that is characterized by negativity for both ER and PR (ER-PR-) or higher 21-gene recurrence scores after ductal carcinoma in situ (DCIS).

METHODS: This study identified 163,892 women (10.5% black, 9.8% Asian, and 8.6% Hispanic) with incident DCIS between 1990 and 2015 from the Surveillance, Epidemiology, and End Results data sets. Cox proportional hazards regression was used to estimate hazards ratios (HRs) of subsequent IBC classified by the hormone receptor status and 21-gene recurrence scores.

RESULTS: During a median follow-up of 90 months, 8333 women developed IBC. In comparison with white women, the adjusted HR of subsequent ER-PR- breast cancer was 1.86 (95% confidence interval [CI], 1.57-2.20) for black women (absolute 10-year difference, 2.2%) and 1.40 (95% CI, 1.14-1.71) for Asian women (absolute 10-year difference, 0.4%); this was stronger than the associations for ER+ and/or PR+ subtypes (Pheterogeneity = .0004). The 21-gene recurrence scores of subsequent early-stage, ER+ IBCs varied by race/ethnicity (Pheterogeneity = .057); black women were more likely than white women to have a recurrence score of 26 or higher (HR, 1.38; 95% CI, 1.00-1.92). No significant difference was observed in the risks of subsequent IBC subtypes for Hispanic women.

CONCLUSIONS: Black and Asian women with DCIS had higher risks of developing biologically aggressive IBC than white counterparts. This should be considered in treatment decisions for black and Asian patients with DCIS.

KEYWORDS: breast cancer; ductal carcinoma in situ; race; recurrence

PMID: 31120565

DOI: 10.1002/cncr.32200