Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, KY.
Department of Pathology, University of Rochester Medical Center, Rochester, NY.
Clin Breast Cancer. 2019 Feb;19(1):e261-e269. doi: 10.1016/j.clbc.2018.10.005. Epub 2018 Oct 29.
The 8th edition of the American Joint Committee on Cancer (AJCC) breast cancer staging system requires histologic grade (GR), estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and stage (assessed by the tumor, node, metastasis classification system). For T1-2 N0, ER/HER2- tumors, if the 21-gene expression assay is ordered and Oncotype DX (ODX) recurrence score (RS) is 0 to 10, the stage is IA. The purpose of this study was to determine the impact of the ODXRS on staging ER/HER2- tumors.
This is a retrospective review of ER/HER2- invasive breast cancer (BC) with ODXRS results from 2 institutions (n = 816) between 2006 and 2018. Stage based on the AJCC 7th and 8th editions, and stage using the 8th edition with and without ODXRS were compared. Significant associations among pathologic parameters and ODX risk groups were determined. Clinical histories were reviewed.
Nearly half of the patients (43%) had a change in BC stage using the new staging system. Only 4 patients changed stage as a direct result of ODXRS. Influence of ODXRS on staging is limited to T2N0 tumors that are either GR 3 and strongly ER and PR or GR 1-2 and ER/PR-. Sixty-one percent of cases of recurrence (11/18) were downstaged using the new staging system.
ODXRS has little influence on staging, thus supporting the view of the AJCC 8th edition expert panel that ODX is not required for staging. Downstaging of more than half of cases of recurrence suggests that continued refinement of the staging system, as proposed by the expert panel, could be beneficial in this subgroup of patients.
第 8 版美国癌症联合委员会（AJCC）乳腺癌分期系统需要组织学分级（GR）、雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体 2（HER2）和分期（通过肿瘤、淋巴结、转移分类系统评估）。对于 T1-2N0、ER/HER2-肿瘤，如果订购了 21 基因表达检测，并且 Oncotype DX（ODX）复发评分（RS）为 0 至 10，则分期为 IA。本研究旨在确定 ODXRS 对 ER/HER2-肿瘤分期的影响。
这是对 2 个机构（n=816）在 2006 年至 2018 年之间进行的 ER/HER2-浸润性乳腺癌（BC）和 ODXRS 结果的回顾性研究。比较了基于 AJCC 第 7 版和第 8 版的分期，以及使用和不使用 ODXRS 的第 8 版分期。确定了病理参数与 ODX 风险组之间的显著相关性。回顾了临床病史。
近一半的患者（43%）使用新的分期系统改变了 BC 分期。只有 4 名患者因 ODXRS 而直接改变了分期。ODXRS 对分期的影响仅限于 T2N0 肿瘤，这些肿瘤要么是 GR3 且强烈 ER 和 PR，要么是 GR1-2 且 ER/PR-。使用新的分期系统，61%的复发病例（11/18）降期。
ODXRS 对分期的影响很小，因此支持 AJCC 第 8 版专家组的观点，即 ODX 不需要用于分期。超过一半的复发病例降期表明，专家组提出的分期系统的进一步细化可能对这组患者有益。
