乳腺癌不同种族患者的二十一基因复发评分有显著差异

　　在临床上，对于诊断为激素受体阳性、人表皮生长因子受体2（HER2）阴性、淋巴结阴性的乳腺癌女性，21基因复发评分可以对乳腺癌治疗后10年远处复发风险进行量化分类（低风险<18；中风险18～30；高风险≥31）。虽然非西班牙裔黑人女性与非西班牙裔白人女性相比，预后较差，但是21基因复发评分对于各个种族人群的等效性尚不明确。

　　2018年1月17日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表密歇根州底特律市韦恩州立大学医学院的研究报告，分析了激素受体阳性、淋巴结阴性乳腺癌患者21基因复发评分的种族差异。

　　该研究通过底特律大都会地区癌症监测系统，找出2010～2014年被诊断为激素受体阳性、HER2阴性、淋巴结阴性、符合临床指南关于21基因复发评分适应证的浸润性乳腺癌女性2216例，其中非西班牙裔白人1824例、非西班牙裔黑人392例。使用多项逻辑回归对种族之间21基因复发评分类别的差异进行量化。

　　结果发现，非西班牙裔黑人与非西班牙裔白人相比：

• 平均复发评分较高：19.3比17.0 （P=0.0003）

• 高风险的肿瘤较多：14.8%比8.3% （P=0.0004）

　　这些差异仅限于诊断时年龄小于65岁的患者：

• 20～49岁复发评分较高：23.6比17.3 （P<0.001）

• 50～64岁复发评分较高：19.6比17.4 （P=0.023）

　　排除年龄、临床分期、肿瘤分级、组织学因素影响后，非西班牙裔黑人与非西班牙裔白人相比，高风险肿瘤比例仍然显著较高（比例比：1.75，95%置信区间：1.18～2.59）。

　　因此，符合21基因复发评分临床指征的非西班牙裔黑人与非西班牙裔白人相比，远处复发风险较高。有必要开展进一步研究观察这些女性将来实际复发情况的是否存在差异，这对于不同种族患者的21基因复发评分校准和治疗推荐意见具有临床意义。

J Clin Oncol. 2018 Jan 17. [Epub ahead of print]

Racial Differences in 21-Gene Recurrence Scores Among Patients With Hormone Receptor-Positive, Node-Negative Breast Cancer.

Andreana N. Holowatyj, Michele L. Cote, Julie J. Ruterbusch, Kristina Ghanem, Ann G. Schwartz, Fawn D. Vigneau, David H. Gorski, Kristen S. Purrington.

Wayne State University, Detroit, MI.

PURPOSE: The 21-gene recurrence score (RS) breast cancer assay is clinically used to quantify risk of 10-year distant recurrence by category (low, < 18; intermediate, 18 to 30; high, ≥ 31) for treatment management among women diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative, lymph node-negative breast cancer. Although non-Hispanic black (NHB) women have worse prognosis compared with non-Hispanic white (NHW) women, the equivalency of 21-gene RS across racial groups remains unknown.

PATIENTS AND METHODS: Using the Metropolitan Detroit Cancer Surveillance System, we identified women who were diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative, lymph node-negative invasive breast cancer between 2010 and 2014. Multinomial logistic regression was used to quantify racial differences in 21-gene RS category.

RESULTS: We identified 2,216 women (1,824 NHW and 392 NHB) with invasive breast cancer who met clinical guidelines for and underwent 21-gene RS testing. The mean RS was significantly higher in NHBs compared with NHWs (19.3 v 17.0, respectively; P=.0003), where NHBs were more likely to present with high-risk tumors compared with NHWs (14.8% v 8.3%, respectively; P=.0004). These differences were limited to patients younger than 65 years at diagnosis, among whom NHBs had significantly higher RS compared with NHWs (20 to 49 years: 23.6 v 17.3, respectively; P < .001 and 50 to 64 years: 19.6 v 17.4, respectively; P=.023). NHBs remained more likely to have high-risk tumors compared with NHWs after adjusting for age, clinical stage, tumor grade, and histology (odds ratio [OR], 1.75; 95% CI, 1.18 to 2.59).

CONCLUSION: NHBs who met clinical criteria for 21-gene RS testing had tumors with higher estimated risks of distant recurrence compared with NHWs. Further study is needed to elucidate whether differences in recurrence are observed for these women, which would have clinical implications for 21-gene RS calibration and treatment recommendations in NHB patients.

PMID: 29341832

DOI: 10.1200/JCO.2017.74.5448