青少年年轻成人乳腺癌幸存者治疗后骨髓抑制长期影响的差异
Disparities in the Occurrence of Long-Term Effects of Bone Marrow Suppression after Treatment in Adolescent Young Adult Breast Cancer Survivors
影响因子:3.50000
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2024 Oct
作者:
A Bellini, T H M Keegan, Q Li, F B Maguire, V Lyo, Candice Sauder
摘要
许多青少年和年轻人（AYA）乳腺癌（BC）患者接受辅助治疗作为初始治疗，长期骨髓抑制是一种潜在的并发症，但没有研究评估种族/族裔对AYA BC幸存者中骨髓抑制发展的影响。并与全州住院数据有关。我们估计了在诊断后出院诊断≥2年后，我们估计了骨髓抑制后期作用的累积发生率，例如白细胞减少，贫血，血小板减少症，出血和感染/败血症。我们使用多元COX比例危害回归研究了社会人口统计学和临床因素对迟到的影响。11,293例患者，42.8％的非西班牙裔（NH）白色，28.8％的西班牙裔，19.5％NH亚洲/太平洋岛民和7.5％的NH NH。在多变量分析中，NH黑人的贫血风险最高（与NH白色）[危险比（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），1.14-2.13），脑膜炎1.14-2.13），脑电图（HR 1.14-2.13），脑电图元素（HR Bombobocytopocytopenia（Thrombobobocytopopenia）（Hr Bombobocytopenia（Hr Bombobocytopenia）（HR/INFROMBOCYSIS Inffocies 9999999999999） （HR 1.64，CI 1.4-1.92）和出血（HR 1.89，CI 1.39-2.58）。西班牙裔患贫血的风险较高（HR 1.17，CI 1.04-1.32），出血（HR 1.4，CI 1.12-1.76）和主要感染/sepsis（HR 1.36，CI 1.21-1.52）。亚洲/太平洋岛民的出血风险较高（HR 1.33，CI 1.03-1.72）。来自邻里社会经济状况较低的患者感染/败血症的风险高20％（HR 1.21，CI 1.1-1.34），但没有其他迟到效应的关联。我们确定NH黑人，西班牙裔，西班牙裔，亚洲/太平洋岛民的种族/族裔/族裔与多种后期耐心治疗的风险增加了耐心治疗的风险。从这些数据中，提供者可以在这些高风险幸存者中对血液学晚期作用进行早期/频繁筛查。
Abstract
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.