Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
BMC Cancer. 2018 Jan 6;18(1):42. doi: 10.1186/s12885-017-3985-y.
The 21-gene recurrence score (RS) assay determines the benefit of adding chemotherapy to endocrine therapy for patients with early stage, estrogen receptor (ER)-positive, HER2-negative breast cancer. The RS risk groups predict the likelihood of distant recurrence and have recently been associated with an increased risk of locoregional recurrence (LRR). This study analyzed clinicopathologic features of patients with low RS and LRR.
In our institutional database, we identified 1396 consecutive female patients with lymph node negative, ER+/HER2- invasive breast carcinoma and low RS (<18) results, treated at our center from 2008 to 2013. We collected data on clinicopathologic features, treatment and outcome.
The median patient age was 57 years (range 22-90). The median tumor size was 1.2 cm (range 0.3-5.8). Overall, 66.6% (930/1396) women were treated with breast conserving surgery (BCS) and radiation therapy, 3.4% (48/1396) with BCS alone, 29.7% (414/1396) with total mastectomy, and 0.3% (4/1396) with total mastectomy and radiation therapy. Most patients (84.8%; 1184/1396) received endocrine therapy alone, 12.1% (169/1396) were treated with chemotherapy plus endocrine therapy, and only 3.1% (43/1396) received no systemic therapy. At a median follow-up of 52 months, 0.9% (13/1396) of patients developed LRR. Sites of LRR included the ipsilateral breast (n = 8), chest wall (n = 3), axillary node (n = 1), and internal mammary node (n = 1). All patients with LRR had negative resection margins at the initial surgery. The rate of LRR in patients treated with adjuvant endocrine therapy alone was 0.7% (8/1184). All eight patients received standard local treatment. Three patients had lymphovascular invasion but no other significant risk factors for LRR were identified.
Our study of node negative, ER+/HER2- breast cancer patients with low RS observed extremely low rates of LRR: 0.9% (13/1396) in the whole cohort and 0.7% (8/1184) in patients treated with endocrine therapy alone. As the largest series to date, we report detailed clinicopathologic data and clinical outcomes of this cohort and provide a comprehensive characterization of patients who developed LRR.
21 基因复发评分 (RS) 检测可确定早期雌激素受体 (ER) 阳性、HER2 阴性乳腺癌患者接受内分泌治疗加化疗的获益。RS 风险组预测远处复发的可能性，并且最近与局部区域复发 (LRR) 的风险增加相关。本研究分析了 RS 低且发生 LRR 的患者的临床病理特征。
在我们的机构数据库中，我们确定了 1396 例连续的淋巴结阴性、ER+/HER2-浸润性乳腺癌且 RS 低 (<18) 的女性患者，这些患者于 2008 年至 2013 年在我们中心接受治疗。我们收集了临床病理特征、治疗和结局的数据。
中位患者年龄为 57 岁（范围 22-90 岁）。中位肿瘤大小为 1.2cm（范围 0.3-5.8cm）。总体而言，66.6%（930/1396）的女性接受了保乳手术 (BCS) 和放射治疗，3.4%（48/1396）仅接受了 BCS，29.7%（414/1396）接受了全乳切除术，0.3%（4/1396）接受了全乳切除术和放射治疗。大多数患者（84.8%；1184/1396）单独接受内分泌治疗，12.1%（169/1396）接受化疗联合内分泌治疗，只有 3.1%（43/1396）未接受全身治疗。中位随访 52 个月时，0.9%（13/1396）的患者发生 LRR。LRR 的部位包括同侧乳房（n=8）、胸壁（n=3）、腋窝淋巴结（n=1）和内乳淋巴结（n=1）。所有发生 LRR 的患者在初始手术时均有阴性切缘。仅接受辅助内分泌治疗的患者 LRR 率为 0.7%（8/1184）。所有 8 例患者均接受了标准的局部治疗。其中 3 例有血管淋巴管侵犯，但未发现其他明显的 LRR 危险因素。
我们对 RS 低的淋巴结阴性、ER+/HER2-乳腺癌患者进行的研究观察到 LRR 的发生率极低：整个队列为 0.9%（13/1396），仅接受内分泌治疗的患者为 0.7%（8/1184）。作为迄今为止最大的系列研究，我们报告了该队列的详细临床病理数据和临床结局，并对发生 LRR 的患者进行了全面特征描述。
