Wu San-Gang, Zhang Wen-Wen, Wang Jun, Dong Yong, Sun Jia-Yuan, Chen Yong-Xiong, He Zhen-Yu
Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
Front Oncol. 2019 Jan 29;9:1. doi: 10.3389/fonc.2019.00001. eCollection 2019.
To assess the role of the 21-gene recurrence score (RS) assay on decision-making of postoperative radiotherapy (RT) following breast-conserving surgery (BCS) in elderly women with early-stage breast cancer. The 21-gene RS for elderly (≥65 years) women with stage T1-2N0M0 estrogen receptor-positive breast cancer who underwent BCS from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results program. We estimated the association of 21-gene RS and adjuvant RT related to breast cancer-specific survival (BCSS) using propensity score matching (PSM). We identified 18,456 patients, of which 15,326 (83.0%) received postoperative RT. Of identified patients, 58.9, 34.0, and 7.1% of patients had a low-, intermediate-, and high-risk RS, respectively. Receipt of postoperative RT was not related to the year of diagnosis according to the 21-gene RS groups. Multivariate analysis suggested that receipt of postoperative RT was an independent predictor of better BCSS before (hazard ratio [HR] 0.587, 95% confidence interval [CI] 0.426-0.809, = 0.001) and after (HR 0.613, 95%CI 0.390-0.963, = 0.034) PSM. However, subgroups analyses indicated that receipt of postoperative RT was related to better BCSS in women with intermediate-risk RS before (HR 0.467, 95%CI 0.283-0.772, = 0.003) and after (HR 0.389, 95%CI 0.179-0.846, = 0.017) PSM, but not in women with low- and high-risk RS groups before and after PSM. Although causation cannot be implied, adjuvant RT in elderly women was associated with a greater effect size in patients with an intermediate-risk RS.
评估21基因复发评分（RS）检测在老年早期乳腺癌保乳手术（BCS）后辅助放疗（RT）决策中的作用。2004年至2015年期间接受BCS的年龄≥65岁、T1-2N0M0期雌激素受体阳性乳腺癌老年女性的21基因RS数据来自监测、流行病学和最终结果计划。我们使用倾向评分匹配（PSM）来估计21基因RS与辅助RT和乳腺癌特异性生存（BCSS）之间的关联。我们共识别出18456例患者，其中15326例（83.0%）接受了术后放疗。在识别出的患者中，分别有58.9%、34.0%和7.1%的患者RS为低、中、高风险。根据21基因RS分组，术后放疗的接受情况与诊断年份无关。多因素分析表明，术后放疗是BCSS改善的独立预测因素，在PSM之前（风险比[HR]0.587，95%置信区间[CI]0.426-0.809，P=0.001）和之后（HR 0.613，95%CI 0.390-0.963，P=0.034）均如此。然而，亚组分析表明，术后放疗与中风险RS女性在PSM之前（HR 0.467，95%CI 0.283-0.772，P=0.003）和之后（HR 0.389，95%CI 0.179-0.846，P=0.017）的BCSS改善相关，但在低风险和高风险RS组的女性中，PSM前后均无此关联。虽然不能暗示因果关系，但老年女性辅助放疗在中风险RS患者中与更大的效应量相关。
