接受21基因表达检测的早期乳腺癌患者的预后
Outcomes in patients with early-stage breast cancer who underwent a 21-gene expression assay.
作者信息
Barcenas Carlos H, Raghavendra Akshara, Sinha Arup K, Syed Masood Pasha, Hsu Limin, Patangan Modesto G, Chavez-MacGregor Mariana, Shen Yu, Hortobagyi Gabriel H, Valero Vicente, Giordano Sharon H, Ueno Naoto T, Tripathy Debu
机构信息
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, The University of Texas School of Public Health, Houston, Texas.
出版信息
Cancer. 2017 Jul 1;123(13):2422-2431. doi: 10.1002/cncr.30618. Epub 2017 Feb 15.
BACKGROUND
Invasive disease-free survival (IDFS) rates are excellent in patients with breast cancer (BC) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-), axillary lymph node-negative (LN-) tumors with a 21-gene expression assay recurrence score (RS) of 0 to 10. However, to the authors' knowledge, the outcomes among patients with an RS of 11 to 25 who are treated with endocrine therapy alone are unknown.
METHODS
In this retrospective single-institution study, the authors described the characteristics of patients with HR+, HER2-, LN- BC who underwent a 21-gene expression assay. In addition, among those individuals diagnosed between 2005 and 2011, we measured IDFS, recurrence-free survival, distant recurrence-free survival, and overall survival rates, focusing on patients with an RS of 11 to 25 by receipt of chemotherapy. The Kaplan-Meier method was used to estimate survival rates and multivariable Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (95% CIs).
RESULTS
Among 1424 patients, the RS distribution was 0 to 10 in 297 patients (21%), 11 to 25 in 894 patients (63%), and >25 in 233 patients (16%); of these, 1.7%, 15%, and 73.4% of patients, respectively, received chemotherapy. With a median follow-up of 58 months, those patients with an RS of 11 to 25 had an IDFS rate at 5 years of 92.6% (95% CI, 89.6%-94.7%), which was comparable between those who received chemotherapy and those who did not. The hazard ratios of the effect of chemotherapy were 1.64 for IDFS (95% CI, 0.73-3.71), 1.46 for recurrence-free survival (95% CI, 0.41-5.23), 1.25 for distant recurrence-free survival (95% CI, 0.32-4.92), and 2.19 for overall survival (95% CI, 0.44-11.0).
CONCLUSIONS
The results of the current study demonstrate similar outcomes with or without chemotherapy in patients with HR+, HER2-, LN- BC who have an RS of 11 to 25, but a benefit from chemotherapy in this group cannot be ruled out. Cancer 2017;123:2422-31. © 2017 American Cancer Society.
背景
对于激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）、腋窝淋巴结阴性（LN-）且21基因表达检测复发评分（RS）为0至10的乳腺癌（BC）患者，无侵袭性疾病生存期（IDFS）率非常理想。然而，据作者所知，仅接受内分泌治疗的RS为11至25的患者的预后情况尚不清楚。
方法
在这项回顾性单机构研究中，作者描述了接受21基因表达检测的HR+、HER2-、LN- BC患者的特征。此外，在2005年至2011年期间确诊的患者中，我们测量了IDFS、无复发生存期、无远处复发生存期和总生存率，重点关注接受化疗的RS为11至25的患者。采用Kaplan-Meier方法估计生存率，采用多变量Cox比例风险模型计算风险比和95%置信区间（95%CI）。
结果
在1424例患者中，RS分布为0至10的有297例（21%），11至25的有894例（63%），>25的有233例（16%）；其中分别有1.7%、15%和73.4%的患者接受了化疗。中位随访58个月，RS为11至25的患者5年IDFS率为92.6%（95%CI，89.6%-94.7%），接受化疗和未接受化疗的患者之间相当。化疗对IDFS的风险比为1.64（95%CI，0.73-3.71），对无复发生存期为1.46（95%CI，0.41-5.23），对无远处复发生存期为1.25（95%CI，0.32-4.92），对总生存率为2.19（95%CI，0.44-11.0）。
结论
本研究结果表明，RS为11至25的HR+、HER2-、LN- BC患者接受或不接受化疗的预后相似，但不能排除该组患者从化疗中获益的可能性。《癌症》2017年；123：2422 - 31。©2017美国癌症协会。
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