青少年及青年乳腺癌幸存者中骨髓抑制长期影响的发生差异性

Disparities in the Occurrence of Long-Term Effects of Bone Marrow Suppression after Treatment in Adolescent Young Adult Breast Cancer Survivors

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ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

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

DOI: 10.1245/s10434-024-15707-w

摘要

许多15-39岁的青少年及青年（AYA）乳腺癌（BC）患者在初次治疗中接受辅助治疗，长期骨髓抑制可能成为一种并发症，但尚无研究评估种族/民族对AYA BC幸存者中骨髓抑制发生的影响。我们从加利福尼亚癌症登记处筛选了2006年至2018年间诊断为BC、生存≥2年的女性患者，并将其与全州住院数据关联。我们估算了在诊断后≥2年，出现白细胞减少症、贫血、血小板减少、出血和感染/败血症等骨髓抑制晚期效应的累积发生率，并采用多变量Cox比例风险模型分析社会人口统计学和临床因素的影响。在11,293名患者中，非西班牙裔白人占42.8%，西班牙裔占28.8%，非西班牙裔亚裔/太平洋岛民占19.5%，非西班牙裔黑人占7.5%。多变量分析显示，非西班牙裔黑人患贫血（HR 1.72，95% CI 1.47-2.02）、白细胞减少（HR 1.56，95% CI 1.14-2.13）、血小板减少（HR 1.46，95% CI 1.08-1.99）、重度感染/败血症（HR 1.64，95% CI 1.4-1.92）及出血（HR 1.89，95% CI 1.39-2.58）的风险最高。西班牙裔患者也表现出较高的贫血（HR 1.17，95% CI 1.04-1.32）、出血（HR 1.4，95% CI 1.12-1.76）及重度感染/败血症（HR 1.36，95% CI 1.21-1.52）风险。亚裔/太平洋岛民仅在出血风险上较高（HR 1.33，95% CI 1.03-1.72）。来自低社会经济状态社区的患者感染/败血症风险增加20%（HR 1.21，95% CI 1.1-1.34），但其他晚期效应未见显著关联。研究表明，非西班牙裔黑人、西班牙裔及亚裔/太平洋岛民的AYA乳腺癌患者在辅助治疗后面临多种晚期骨髓抑制的风险增加。临床上应对这些高风险幸存者实施早期和频繁的血液学晚期效应筛查。

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.