21 基因复发评分检测对老年乳腺癌患者辅助化疗决策的影响。
Impact of 21-gene recurrence score testing on adjuvant chemotherapy decision making in older patients with breast cancer.
机构信息
Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Department of clinical laboratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
出版信息
J Geriatr Oncol. 2020 Jun;11(5):843-849. doi: 10.1016/j.jgo.2019.10.006. Epub 2019 Nov 6.
PURPOSE
To evaluate the role of 21-gene recurrence score (RS) assay in adjuvant chemotherapy decision-making among older patients with early breast cancer.
METHODS
Consecutive hormonal receptor-positive, aged ≥60 patients with breast cancer were enrolled from Shanghai Ruijin Hospital between January 2014 and December 2017. Treatment decisions were made by multi-disciplinary team (MDT) before and after 21-gene RS testing, and the actual treatment for each patient was also analyzed.
RESULTS
A total of 511 patients were enrolled, with 331 (64.8%) aged between 60 and 69, 140 (27.4%) between 70 and 79, and 40 (7.8%) over 80 years. There were 138 (27.0%), 287 (56.2%), and 86 (16.8%) patients classified as low, intermediate, and high risk RS, respectively. Multivariable analysis demonstrated that age, tumor stage, nodal status, PR expression, Ki-67, and 21-gene RS were independent impact factors for chemotherapy recommendations (P < .05). Patients with high risk RS and intermediate risk RS (both P < .001) were more often recommended to receive chemotherapy than patients with low risk RS. Treatment recommendations changed in 74 (14.5%) patients after 21-gene RS testing: 17 (3.3%) from chemotherapy to no chemotherapy and 57 (11.2%) from no chemotherapy to chemotherapy. Overall compliance rate to MDT recommendation after 21-gene RS testing was 95.7%.
CONCLUSION
An intermediate and/or high risk 21-gene RS assay was independently associated with receiving adjuvant chemotherapy among older patients with breast cancer. However, it showed a limited impact on adjuvant chemotherapy decision-making. After 21-gene RS testing, compliance with MDT recommendation was relatively high in older patients with breast cancer.
目的
评估 21 基因复发评分（RS）检测在老年早期乳腺癌患者辅助化疗决策中的作用。
方法
连续纳入 2014 年 1 月至 2017 年 12 月期间于上海瑞金医院就诊的激素受体阳性、年龄≥60 岁的乳腺癌患者。在进行 21 基因 RS 检测前后，通过多学科团队（MDT）制定治疗决策，并对每位患者的实际治疗进行分析。
结果
共纳入 511 例患者，其中 331 例（64.8%）年龄在 60-69 岁之间，140 例（27.4%）年龄在 70-79 岁之间，40 例（7.8%）年龄超过 80 岁。低、中、高危 RS 患者分别为 138 例（27.0%）、287 例（56.2%）和 86 例（16.8%）。多变量分析显示，年龄、肿瘤分期、淋巴结状态、PR 表达、Ki-67 和 21 基因 RS 是化疗建议的独立影响因素（P<0.05）。高危 RS 和中危 RS 患者（均 P<0.001）较低危 RS 患者更倾向于接受化疗。21 基因 RS 检测后，74 例（14.5%）患者的治疗建议发生变化：17 例（3.3%）由化疗改为非化疗，57 例（11.2%）由非化疗改为化疗。21 基因 RS 检测后，MDT 建议的总体依从率为 95.7%。
结论
中危和/或高危 21 基因 RS 检测与老年乳腺癌患者接受辅助化疗独立相关。然而，它对辅助化疗决策的影响有限。21 基因 RS 检测后，老年乳腺癌患者对 MDT 建议的依从性相对较高。
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