Impact of Ethnicity on Breast Cancer Outcome: A Systematic Review and Meta-Analysis of Randomized Phase III Trials of the Last Decade.

IF 3 Q2 ONCOLOGY

JCO Global Oncology Pub Date : 2025-07-01 DOI:10.1200/GO-25-00139

Emma Zattarin, Luca Moscetti, Elisa D'Agostino, Alberto Bertolotti, Isabella Sperduti, Chiara Chiavelli, Fabio Canino, Federico Piacentini, Laura Cortesi, Massimo Dominici, Angela Toss

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Abstract

Purpose: It remains uncertain whether ethnicity affects the benefit derived from novel breast cancer (BC) treatments. Thus, we conducted a systematic review and meta-analysis to evaluate the heterogeneity of treatment efficacy across different ethnic groups, in both the advanced BC (aBC) setting and the early BC (eBC) setting.

Methods: We systematically searched PubMed, Embase, and Scopus for phase III randomized controlled trials (RCTs) leading to BC drug approval between 2013 and 2023 that had available hazard ratios (HRs) for outcome according to ethnicity. We excluded nonrandomized studies. We compared the three most represented ethnic groups, Whites, Asians, and Blacks, among themselves and with other underrepresented groups (UGs). The pooled HRs and 95% CI in ethnic subgroups were calculated using a random-effects model, and the heterogeneity between the estimates was assessed with an interaction test.

Results: Among 23 selected RCTs (14,000 patients) in the aBC setting, 20 provided HRs (95% CI) for progression-free survival (PFS) in the subgroup of Whites, 17 for Asians, four for Blacks, and 23 for non-Asians (Whites + all non-Asian UG) or non-Whites (Asians + all non-Asian UG). Risk of bias was low for all the included RCTs. The HRs for PFS with experimental versus control drugs were 0.62 (95% CI, 0.57 to 0.68) for Whites, 0.54 (95% CI, 0.44 to 0.66) for Asians, and 0.54 (95% CI, 0.34 to 0.85) for Blacks with no significant interethnic difference (P = .233 for Whites v Asians, P = .564 for Whites v Blacks, P = .992 for Asians v Blacks). Similarly, Whites versus non-Whites and Asians versus non-Asians showed no significantly different magnitude of benefit (P = .406 and P = .226, respectively). No differences were observed in eBC trials either.

Conclusion: These results offer reassurance for the broader applicability of clinical trial results despite ethnic imbalance.

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种族对乳腺癌预后的影响：过去十年随机III期试验的系统回顾和荟萃分析。

目的：尚不确定种族是否会影响新型乳腺癌（BC）治疗的获益。因此，我们进行了系统回顾和荟萃分析，以评估不同种族的晚期BC （aBC）和早期BC （eBC）治疗效果的异质性。方法：我们系统地检索PubMed、Embase和Scopus，检索2013年至2023年间导致BC药物批准的III期随机对照试验（rct），这些试验具有根据种族结果的可用风险比（hr）。我们排除了非随机研究。我们比较了三个最具代表性的种族群体，白人，亚洲人和黑人，他们之间以及其他代表性不足的群体（UGs）。使用随机效应模型计算族裔亚组的合并hr和95% CI，并通过相互作用检验评估估计值之间的异质性。结果：在aBC设置的23项随机对照试验（14,000例患者）中，20项提供了白人亚组无进展生存期（PFS）的HRs (95% CI)， 17项为亚洲人，4项为黑人，23项为非亚洲人（白人+所有非亚洲人UG）或非白人（亚洲人+所有非亚洲人UG）。所有纳入的rct偏倚风险均较低。白人与对照药物的PFS的hr分别为0.62 (95% CI, 0.57 ~ 0.68)，亚洲人为0.54 (95% CI, 0.44 ~ 0.66)，黑人为0.54 (95% CI, 0.34 ~ 0.85)，没有显著的种族间差异（白人vs亚洲人P = 0.233，白人vs黑人P = 0.564，亚洲人vs黑人P = 0.992）。同样，白人与非白人、亚洲人与非亚洲人的获益程度也没有显著差异（P = 0.406和P = 0.226）。在eBC试验中也没有观察到差异。结论：尽管种族不平衡，但这些结果为临床试验结果的广泛适用性提供了保证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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