Choi In Sil, Jung Jiwoong, Kim Byoung Hyuck, Oh Sohee, Kim Jongjin, Park Jin Hyun, Park Jeong Hwan, Hwang Ki-Tae
Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea.
Department of Surgery, Seoul Medical Center, Seoul 02053, Korea.
Cancers (Basel). 2020 Jul 8;12(7):1829. doi: 10.3390/cancers12071829.
To evaluate the performance of the 21-gene recurrence score (RS) assay in predicting chemotherapy benefit in the Surveillance, Epidemiology, and End Results population, we aimed to assess breast cancer-specific mortality (BCSM) by chemotherapy use within each of the RS categories.
Data on breast cancer (BC) cases diagnosed between 2004 and 2015 with available RS results were released. Our analysis included patients with hormone receptor-positive, node-negative early-stage BC ( = 89,402), and three RS groups were defined; RS < 11, low; RS 11-25, intermediate; RS > 25, high. A propensity score matched-analysis was performed to assess and compare BCSM.
Chemotherapy was significantly associated with a reduced risk of BC death among patients in the high RS group (hazard ratio = 0.782; 95% CI, 0.618-0.990; = 0.041). However, in the low and intermediate RS groups, there were no significant differences in BCSM between patients who received chemotherapy and those who did not. Among those with RS 11-25, chemotherapy benefit varied with tumor size ( = 0.001).
Our findings provide real-world evidence that the 21-gene RS assay is predictive of chemotherapy benefit among patients in clinical practice. More refined risk estimates would be needed for patients with an intermediate RS.
为了评估21基因复发评分（RS）检测在监测、流行病学和最终结果人群中预测化疗获益的性能，我们旨在通过在每个RS类别中使用化疗来评估乳腺癌特异性死亡率（BCSM）。
发布了2004年至2015年间诊断的乳腺癌（BC）病例的数据，这些病例有可用的RS结果。我们的分析包括激素受体阳性、淋巴结阴性的早期BC患者（n = 89402），并定义了三个RS组；RS < 11，低；RS 11 - 25，中；RS > 25，高。进行倾向评分匹配分析以评估和比较BCSM。
在高RS组患者中，化疗与BC死亡风险降低显著相关（风险比 = 0.782；95% CI，0.618 - 0.990；P = 0.041）。然而，在低RS组和中RS组中，接受化疗的患者与未接受化疗的患者之间的BCSM没有显著差异。在RS为11 - 25的患者中，化疗获益随肿瘤大小而异（P = 0.001）。
我们的研究结果提供了真实世界的证据，表明21基因RS检测在临床实践中可预测患者的化疗获益。对于RS中等的患者，需要更精确的风险估计。
