一种平衡行为:在诊断为乳腺癌的妇女中心血管疾病死亡率的种族差异。

Annals of cancer epidemiology Pub Date : 2020-03-01 Epub Date: 2020-03-31 DOI:10.21037/ace.2020.01.02
Lindsay J Collin, Alyssa N Troeschel, Yuan Liu, Keerthi Gogineni, Kylee Borger, Kevin C Ward, Lauren E McCullough
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引用次数: 9

摘要

背景:乳腺癌治疗的心脏毒性作用在临床试验中得到了充分的证明。然而,临床试验往往不能充分代表心血管疾病(CVD)相关结果的最高风险人群,并且对更大的乳腺癌人群的推广能力有限。此外,治疗相关心血管疾病死亡率的种族差异还有待探索。在这项研究中,我们试图量化乳腺癌治疗与CVD死亡率之间的关系,并探讨这种影响在非西班牙裔黑人(NHB)和白人(NHW)妇女之间是否存在差异。方法:使用来自乔治亚州癌症登记处的数据,我们确定了居住在亚特兰大大都会地区(n=3,580 NHB;n= 4923 NHW),并追踪他们的死亡率,直到2018年12月31日。所关注的暴露包括有潜在心脏毒性作用的治疗方法,包括化疗和激素治疗,这些都是由GCR常规收集的。GCR中没有捕获单个药物,因此使用文本描述的自然语言处理识别曲妥珠单抗。我们使用倾向评分加权Cox比例风险回归来计算整个队列和种族中每种治疗方式与心血管疾病死亡率之间的风险比(hr)和95%置信区间(CIs)。结果:在整个队列中,接受化疗(HR =1.10, 95% CI: 0.62, 1.96)和激素治疗(HR =0.94, 95% CI: 0.59, 1.50)的女性与未接受相应治疗的女性相比,心血管疾病死亡率的风险相似。相比而言,接受曲妥珠单抗治疗的女性心血管疾病死亡率风险高于未接受曲妥珠单抗治疗的女性(HR =2.05, 95% CI: 0.76, 5.52)。在种族特异性模型中,激素治疗与NHB女性较高的心血管疾病死亡风险相关(HR =2.18, 95% CI: 0.78, 6.12),但与NHW女性无关(HR =0.66, 95% CI: 0.39, 1.13)。化疗也发现了类似的关联,尽管有所减弱。由于低患病率和事件数量不足,我们无法调查曲妥珠单抗的种族特异性效应。结论:在我们的研究中,我们观察到在NHB妇女中化疗和激素治疗与CVD死亡率有更明显的关联,我们知道这些妇女在乳腺癌诊断时有更多的CVD相关合并症。患者可能受益于在治愈性乳腺癌治疗和预防心血管疾病相关事件和死亡率之间找到平衡的治疗计划。心血管疾病相关的结果可能与患有激素受体阳性疾病的妇女最为相关,因为她们有共同的风险因素(如肥胖、吸烟、体育活动)和较长的生存期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A balancing act: racial disparities in cardiovascular disease mortality among women diagnosed with breast cancer.

Background: The cardiotoxic effects of breast cancer therapies are well documented in clinical trials. However, clinical trials often underrepresent those at highest risk for cardiovascular disease (CVD)related outcomes and have limited generalizability to the larger breast cancer population. In addition, racial differences in treatment-associated CVD mortality have yet to be explored. In this study, we sought to quantify the relationship between breast cancer therapies and CVD mortality, and explore whether this effect differed between non-Hispanic black (NHB) and white (NHW) women.

Methods: Using data from the Georgia Cancer Registry, we identified women diagnosed with a first primary invasive breast cancer [2010-2014], residing in the metropolitan Atlanta area (n=3,580 NHB; n=4,923 NHW), and followed them for mortality through December 31, 2018. Exposures of interest included therapies with potential cardiotoxic effects including chemotherapy and hormone therapy, which are routinely collected by the GCR. Individual agents are not captured within the GCR, therefore trastuzumab was identified using natural language processing of textual descriptions. We used propensity score weighted Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between each treatment modality and CVD mortality among the overall cohort and by race.

Results: In the overall cohort, similar hazards of CVD mortality were found among women treated with chemotherapy (HR =1.10, 95% CI: 0.62, 1.96) and hormone therapy (HR =0.94, 95% CI: 0.59, 1.50), compared to women who did not receive the respective treatments. In contrast, women treated with trastuzumab had a higher hazard of CVD mortality compared to women not treated with trastuzumab (HR =2.05, 95% CI: 0.76, 5.52). In race-specific models, hormone therapy was associated with a higher hazard of CVD mortality among NHB women (HR =2.18, 95% CI: 0.78, 6.12), but not NHW women (HR =0.66, 95% CI: 0.39, 1.13). Similar, albeit attenuated, associations were found for chemotherapy. We were unable to investigate race-specific effects of trastuzumab due to low prevalence and insufficient number of events.

Conclusions: In our study, we observed more pronounced associations of chemotherapy and hormone therapy with CVD mortality among NHB women, for whom we know have greater CVD-related comorbidities at breast cancer diagnosis. Patients may benefit from treatment plans that find a balance between curative breast cancer treatment and prevention of CVD-related events and mortality. CVD-related outcomes may be most relevant for women with hormone receptor positive disease due to shared risk factors (e.g., obesity, tobacco use, physical activity) and longer survival.

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