乳腺癌幸存者的第二次原发性癌症,按种族/族裔和亚洲亚组划分:一项描述性的流行病学研究
Lizi Shao1, Yuntong Wang1, Yiwey Shieh1,2
1Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
Journal of the National Cancer Institute
|December 24, 2025
概括
乳腺癌幸存者面临着第二次原发性癌症 (SPC) 和生存结果的不同风险. 分析揭示了显著的种族和民族差异,突出了个性化护理策略的必要性.
科学领域:
- 在瘤学瘤学.
- 癌症流行病学 癌症流行病学
- 健康差异 在健康上的差异
背景情况:
- 乳腺癌治疗的进步导致了生存率的提高.
- 这导致越来越多的幸存者面临第二次原发性癌症 (SPC) 风险.
- 现有的研究表明,SPC风险存在种族差异,但不同亚裔美国人亚组中的模式尚不清楚,SPC后的种族/种族生存结果也不清楚.
研究的目的:
- 调查乳腺癌幸存者中SPCs的发生率和模式.
- 分析不同种族/族群和特定亚洲亚组的SPC后生存结果.
- 识别SPC风险和死亡影响的差异,为量身定制的护理策略提供信息.
主要方法:
- 利用了来自监测,流行病学和最终结果 (SEER) 数据库的数据,用于在2010-2020年期间被诊断为I-III阶段乳腺癌的女性.
- 按种族/种族 (亚洲人,黑人,西班牙人,太平洋岛民,白人) 和亚洲子组 (中国人,菲律宾人,印度人/巴基斯坦人,日本人,韩国人,越南人) 累计SPC发病率和SPC后生存率的分层分析.
- 采用用SPC作为时间变化的共变量的Cox模型,以准确评估SPC发展和整体存活之间的关联,减轻不朽时间偏差.
主要成果:
- 在430,823名幸存者中,5年SPC发生率在白人 (6.2%) 中最高,在太平洋岛民 (4.2%) 幸存者中最低.
- 在亚洲子组中观察到显著的异质性:中国幸存者患病率最高 (5.4%),而印度/巴基斯坦幸存者患病率最低 (3.7%).
- SPC显著增加了死亡风险 (aHR=3.85). 这种关联在太平洋岛民 (aHR=5.85) 和越南幸存者 (aHR=7.93) 中最为明显,而在白人 (aHR=3.68) 和韩国幸存者 (aHR=3.45) 中最少.
结论:
- 白人和中国幸存者对SPCs的风险最高.
- 太平洋岛民和越南幸存者在SPC开发后经历了更大的死亡影响.
- 这些种族分类的发现强调了关键的异质性,以及为美国不同乳腺癌患者群体量身定制的生存护理计划的必要性.
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