Yu Jing, Wu Jiayi, Huang Ou, He Jianrong, Li Zhu, Chen Weiguo, Li Yafen, Chen Xiaosong, Shen Kunwei
Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2020 May 12;10:708. doi: 10.3389/fonc.2020.00708. eCollection 2020.
Hormone receptor (HR)-positive breast cancer patients with tumor size ≤1.0 cm and negative node have favorable outcomes. The 21-gene Recurrence Score (RS) could predict response to chemotherapy for HR+ breast cancer, but its role in T1bN0 disease is challenging. T1bN0 breast cancer patients diagnosed between January 2014 and June 2019 with RS results were included and categorized as Low- (RS < 18), Intermediate- (RS 18-30), or High-risk (RS > 30) groups. Univariate and multivariate analysis were used to assess factors associated with RS distribution and chemotherapy recommendation. Chemotherapy decisions change and patient adherence after 21-gene RS testing were also evaluated. Among 237 patients with T1bN0 tumors, proportions of Low-, Intermediate-, and High-risk RS were 19.8, 63.3, and 16.9%, respectively. Multivariate analysis found that ER expression ( = 0.011), PR expression ( < 0.001), and Ki-67 index ( = 0.001) were independently associated with RS distribution. Adjuvant chemotherapy was recommended for 31.6% of patients, which was more frequently given to patients with higher tumor grade [Odds ratio (OR) = 2.99 for grade II, OR = 59.19 for grade III, = 0.006], lymph vascular invasion (OR = 8.22, = 0.032), Luminal-B subtype (OR = 5.68, < 0.001), and Intermediate-to High-risk RS (OR = 10.01 for Intermediate-risk, OR = 192.42 for High-risk, < 0.001). Chemotherapy decision change was found in 18.6% of patients, mainly in those with Intermediate- to High-risk RS tumor with the majority from no-chemotherapy to chemotherapy. The treatment compliance rate after the 21-gene RS testing with MDT was 95.4%. RS category was related to ER, PR, and Ki-67 expression, which was recognized as an independent factor of chemotherapy recommendation in T1bN0 breast cancer. The 21-gene RS testing would lead to a chemotherapy decision change rate of 18.6% as well as a high treatment adherence, which can be applied in T1bN0 patients.
肿瘤大小≤1.0 cm且淋巴结阴性的激素受体（HR）阳性乳腺癌患者预后良好。21基因复发评分（RS）可预测HR +乳腺癌对化疗的反应，但其在T1bN0疾病中的作用仍具有挑战性。纳入2014年1月至2019年6月间诊断的有RS结果的T1bN0乳腺癌患者，并将其分为低风险（RS <18）、中风险（RS 18 - 30）或高风险（RS> 30）组。采用单因素和多因素分析评估与RS分布及化疗推荐相关的因素。还评估了21基因RS检测后化疗决策的变化及患者依从性。在237例T1bN0肿瘤患者中，低、中、高风险RS的比例分别为19.8%、63.3%和16.9%。多因素分析发现，雌激素受体（ER）表达（P = 0.011）、孕激素受体（PR）表达（P <0.001）和Ki-67指数（P = 0.001）与RS分布独立相关。31.6%的患者被推荐接受辅助化疗，肿瘤分级较高的患者更常接受化疗[II级的优势比（OR）= 2.99，III级的OR = 59.19，P = 0.006]、存在淋巴管浸润（OR = 8.22，P = 0.032）、Luminal-B亚型（OR = 5.68，P <0.001）以及中高风险RS（中风险的OR = 10.01，高风险的OR = 192.42，P <0.001）。18.6%的患者化疗决策发生改变，主要是中高风险RS肿瘤患者，大多数从无化疗改为化疗。多学科团队（MDT）进行21基因RS检测后的治疗依从率为95.4%。RS类别与ER、PR和Ki-67表达相关，这被认为是T1bN0乳腺癌化疗推荐的独立因素。21基因RS检测会导致18.6%的化疗决策改变率以及较高的治疗依从性，可应用于T1bN0患者。
