Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Breast Cancer Res Treat. 2019 Jul;176(1):95-100. doi: 10.1007/s10549-018-05088-6. Epub 2019 Apr 11.
Determining the need for adjuvant chemotherapy in estrogen receptor (ER)+ disease can be influenced by pathological characteristics and gene expression assays [i.e., Oncotype Dx recurrence scores (RSs)]. The primary objective of this study is to investigate the relationship between the RSs and pathological markers in younger (< 50) versus older (≥ 50) women with early-stage node-negative ER+ breast cancer.
This was a single academic-center retrospective cohort study. Subjects who underwent Oncotype gene expression testing were retrospectively and sequentially identified. 436 Subjects were identified of which 344 were eligible for analysis (133 younger subjects < 50 years of age, and 211 older subjects ≥ 50 years). Pathological data assessed included the progesterone receptor (PR), histological grade (grade), Ki-67, and P53. A multivariable regression analysis was performed using age, PR, and grade as predictor variables for RS. Adjusted R was determined. To investigate the primary objective, subjects were stratified based on age, PR, and grade status in that sequence. Within each tumor subtype as determined by PR and grade statuses, the RSs in the younger versus older age group were compared using Student's t-test and the differences in the 95% confidence interval limits in RS means calculated. Age influence on adjuvant chemotherapy recommendation was also assessed by stratifying subjects based on age (< 50 vs. ≥ 50) and then by RS risk group (≤ 10, 11-25, ≥ 26). Subsequently, the proportions of younger versus older subjects within identical RS risk groups who were explicitly advised by their oncologist to proceed with chemotherapy as documented in their electronic health records were compared using χ test.
Based on the multivariable regression analysis, the adjusted R was 0.229232 and RS was found to be independent of age (p = 0.7169). Between younger and older subjects with tumors with similar PR and grade pathological features, the differences in the RS were insignificant (p > 0.05). Chemotherapy was recommended in younger versus older women, in 0% when the RS was ≤ 10, 39% and 40% when the RS was 11-25 (p = 0.82), and 100% and 98% when the RS was ≥ 26 (p = 0.51), respectively.
The relationship between pathological features and RS is consistent irrespective of age; therefore, models predicting RS may be applicable irrespective of age.
雌激素受体（ER）+疾病中辅助化疗的需求可能受到病理特征和基因表达检测的影响[即，Oncotype Dx 复发评分（RSs）]。本研究的主要目的是研究 RSs 与早期淋巴结阴性 ER+乳腺癌中较年轻（<50 岁）和较年长（≥50 岁）女性的病理标志物之间的关系。
这是一项单中心回顾性队列研究。回顾性和连续鉴定接受 Oncotype 基因表达检测的受试者。确定了 436 名受试者，其中 344 名符合分析条件（<50 岁的年轻受试者 133 名，≥50 岁的年长受试者 211 名）。评估的病理数据包括孕激素受体（PR）、组织学分级（grade）、Ki-67 和 P53。使用年龄、PR 和分级作为预测变量，采用多元回归分析对 RS 进行分析。确定调整后的 R 值。为了研究主要目标，根据年龄、PR 和分级状态对受试者进行分层。根据 PR 和分级状态确定的每个肿瘤亚型内，使用学生 t 检验比较年轻与年长年龄组的 RS，并计算 RS 均值的 95%置信区间限制中的差异。还通过基于年龄（<50 岁与≥50 岁）和 RS 风险组（≤10、11-25、≥26）对受试者进行分层，评估年龄对辅助化疗建议的影响。随后，比较电子病历中记录的接受化疗建议的年轻与年长受试者在相同 RS 风险组中的比例，使用 χ2 检验。
基于多元回归分析，调整后的 R 为 0.229232，发现 RS 与年龄无关（p=0.7169）。在具有相似 PR 和分级病理特征的年轻与年长肿瘤患者之间，RS 差异无统计学意义（p>0.05）。在 RS≤10 时，年轻与年长女性中推荐化疗的比例分别为 0%和 39%和 40%（p=0.82），RS 为 11-25 时分别为 100%和 98%（p=0.51）。
病理特征与 RS 之间的关系是一致的，与年龄无关；因此，预测 RS 的模型可能与年龄无关。
