Academic Department of Biochemistry, Royal Marsden Hospital, and Breakthrough Breast Cancer Centre, Institute of Cancer Research, London, SW3 6JJ, United Kingdom.
J Clin Oncol. 2013 Aug 1;31(22):2783-90. doi: 10.1200/JCO.2012.46.1558. Epub 2013 Jul 1.
Risk of distant recurrence (DR) among women with estrogen receptor (ER) -positive early breast cancer is the major determinant of recommendations for or against chemotherapy. It is frequently estimated using the Oncotype DX recurrence score (RS). The PAM50 risk of recurrence (ROR) score provides an alternative approach, which also identifies intrinsic subtypes.
mRNA from 1,017 patients with ER-positive primary breast cancer treated with anastrozole or tamoxifen in the ATAC trial was assessed for ROR using the NanoString nCounter. Likelihood ratio (LR) tests and concordance indices (c indices) were used to assess the prognostic information provided beyond that of a clinical treatment score (CTS) by RS, ROR, or IHC4, an index of DR risk derived from immunohistochemical assessment of ER, progesterone receptor, human epidermal growth factor receptor 2 (HER2), and Ki67.
ROR added significant prognostic information beyond CTS in all patients (Δ LR-χ(2) = 33.9; P < .001) and in all four subgroups: node negative, node positive, HER2 negative, and HER2 negative/node negative; more information was added by ROR than by RS. C indices in the HER2-negative/node-negative subgroup were 0.73, 0.76, and 0.78 for CTS, CTS plus RS, and CTS plus ROR, respectively. More patients were scored as high risk and fewer as intermediate risk by ROR than by RS. Relatively similar prognostic information was added by ROR and IHC4 in all patients but more by ROR in the HER2-negative/node-negative group.
ROR provides more prognostic information in endocrine-treated patients with ER-positive, node-negative disease than RS, with better differentiation of intermediate- and higher-risk groups.
雌激素受体（ER）阳性早期乳腺癌患者的远处复发（DR）风险是推荐或反对化疗的主要决定因素。它通常使用 Oncotype DX 复发评分（RS）来估计。PAM50 复发风险（ROR）评分提供了一种替代方法，它还可以识别内在亚型。
在 ATAC 试验中，用阿那曲唑或他莫昔芬治疗的 1017 例 ER 阳性原发性乳腺癌患者的 mRNA 用 NanoString nCounter 进行 ROR 评估。似然比（LR）检验和一致性指数（c 指数）用于评估 RS、ROR 或 IHC4 提供的预后信息是否超过 RS、ROR 或 IHC4 的临床治疗评分（CTS）。来自 ER、孕激素受体、人表皮生长因子受体 2（HER2）和 Ki67 的免疫组织化学评估的 DR 风险指数。
ROR 在所有患者（ΔLR-χ(2) = 33.9；P <.001）和所有四个亚组中（淋巴结阴性、淋巴结阳性、HER2 阴性和 HER2 阴性/淋巴结阴性）提供了重要的预后信息，比 RS 提供的信息更多。HER2 阴性/淋巴结阴性亚组的 C 指数分别为 CTS、CTS 加 RS 和 CTS 加 ROR 的 0.73、0.76 和 0.78。ROR 比 RS 更多地将患者评分归类为高危和中危。ROR 和 IHC4 在所有患者中提供了相对相似的预后信息，但在 HER2 阴性/淋巴结阴性组中 ROR 提供的信息更多。
ROR 在接受内分泌治疗的 ER 阳性、淋巴结阴性疾病患者中提供了比 RS 更多的预后信息，并且更好地区分了中危和高危组。
