Ueno Takayuki, Saji Shigehira, Masuda Norikazu, Iwata Hiroji, Kuroi Katsumasa, Sato Nobuaki, Takei Hiroyuki, Yamamoto Yutaka, Ohno Shinji, Yamashita Hiroko, Hisamatsu Kazufumi, Aogi Kenjiro, Sasano Hironobu, Toi Masakazu
Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan.
Medical Oncology, Fukushima Medical University, Fukushima, Japan.
ESMO Open. 2019 Feb 27;4(1):e000476. doi: 10.1136/esmoopen-2018-000476. eCollection 2019.
Neoadjuvant endocrine therapy (NET) can improve surgical outcomes in postmenopausal patients with hormone receptor-positive breast cancer. The Ki67 labelling index after NET has a better prognostic power than that at baseline. However, it remains unknown whether a multigene assay with post-treatment samples could predict the prognosis better than that with pretreatment samples.
The prognostic value of the multigene assay Oncotype DX Recurrence Score (RS) was investigated using pretreatment and post-treatment samples from a multicentre NET trial, JFMC34-0601 (UMIN C000000345), where exemestane was given at 25 mg/day for 24 weeks.
Both pretreatment and post-treatment RSs were significantly associated with disease-free survival (DFS) (p=0.005 and 0.002, respectively). The combination of pretreatment and post-treatment RSs was also a predictor of DFS (p=0.002) and superior to preoperative endocrine prognostic index (PEPI). Furthermore, combined RS was the only independent prognostic factor in the multivariate analysis among the three RSs (p=0.04). In addition, combined RS could differentiate early recurrence in the high-risk group from mid/late recurrence in the intermediate-risk group, suggesting possible differential treatment strategies based on the risk categories indicated by the combined RS.
The combination of pretreatment and post-treatment RSs could provide pivotal information for predicting DFS and differentiating early recurrence in the high-risk group from mid/late recurrence in the intermediate-risk group in patients with hormone receptor-positive breast cancer. A larger study is required to validate the results.
新辅助内分泌治疗（NET）可改善绝经后激素受体阳性乳腺癌患者的手术结局。NET后的Ki67标记指数比基线时具有更好的预后预测能力。然而，使用治疗后样本的多基因检测是否比治疗前样本能更好地预测预后仍不清楚。
使用多中心NET试验JFMC34 - 0601（UMIN C000000345）的治疗前和治疗后样本，研究多基因检测Oncotype DX复发评分（RS）的预后价值，该试验中依西美坦以每日25 mg给药24周。
治疗前和治疗后的RS均与无病生存期（DFS）显著相关（分别为p = 0.005和0.002）。治疗前和治疗后RS的组合也是DFS的预测指标（p = 0.002），且优于术前内分泌预后指数（PEPI）。此外，在三个RS的多因素分析中，联合RS是唯一的独立预后因素（p = 0.04）。此外，联合RS可区分高危组的早期复发与中/低危组的中/晚期复发，提示基于联合RS所指示的风险类别可能采取不同的治疗策略。
治疗前和治疗后RS的组合可为预测激素受体阳性乳腺癌患者的DFS以及区分高危组的早期复发与中/低危组的中/晚期复发提供关键信息。需要更大规模的研究来验证结果。
