Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Turin, Turin, Italy.
School of Medicine, University of Turin, Turin, Italy.
Clin Breast Cancer. 2021 Feb;21(1):e53-e62. doi: 10.1016/j.clbc.2020.06.008. Epub 2020 Jun 30.
More than 50% of estrogen receptor (ER)-positive breast cancer (BC) distant recurrences (DR) develop after the completion of 5 years of adjuvant endocrine therapy (ET). Its extension is beneficial on disease-free survival and overall survival but increases therapy-related side effects. Selecting patients who could benefit the most from an extended regimen has become an increasing need. Clinical Treatment Score at 5 Years (CTS5) is a prognostic tool using clinicopathologic data to estimate DR risk after 5 years of ET for ER BC. We sought to validate the prognostic value of CTS5 in a retrospective cohort of real-life pre- and postmenopausal patients diagnosed with ER BC.
CTS5 was calculated for 603 patients diagnosed with ER BC at Umberto I Hospital of Turin and DR-free after 5 years of ET. Primary endpoint was late DR (LDR) rate.
Median follow-up was 8 years (range, 6-26 years). The 426 postmenopausal women were categorized by CTS5 as follows: 152 low risk, 139 intermediate risk, and 135 high risk. LDR rates were 3.9%, 7.2%, and 15.6%, respectively. CTS5 results were prognostic for LDR: patients with CTS5-high showed a fourfold risk of developing an LDR compared to patients with CTS5-low (hazard ratio, 4.48; 95% confidence interval, 1.80-11.1). The same analysis was conducted for the 177 premenopausal women: 88 low risk, 40 intermediate risk, and 49 high risk. LDR rate were 5.6%, 7.5%, and 20.4%, respectively, proving CTS5 to be prognostic for premenopausal patients as well (CTS5-high vs. CTS5-low: hazard ratio, 3.40; 95% confidence interval, 1.06-11.0).
CTS5 was shown to be prognostic of the risk of LDR in our population of real-life pre- and postmenopausal patients. Our results support its use in clinical practice to better tailor the prescription of extended ET.
超过 50%的雌激素受体（ER）阳性乳腺癌（BC）远处复发（DR）在辅助内分泌治疗（ET）完成 5 年后发生。延长治疗时间有益于无病生存和总生存，但会增加治疗相关的副作用。选择最能从延长治疗方案中获益的患者已成为日益增长的需求。临床治疗评分 5 年（CTS5）是一种使用临床病理数据来估计 ER BC 接受 5 年 ET 后 DR 风险的预后工具。我们旨在通过对在都灵 Umberto I 医院诊断为 ER BC 的真实生活中绝经前和绝经后患者的回顾性队列进行验证，以验证 CTS5 的预后价值。
计算了 603 例在都灵 Umberto I 医院诊断为 ER BC 且 ET 后 5 年无 DR 的患者的 CTS5。主要终点为晚期 DR（LDR）发生率。
中位随访时间为 8 年（范围，6-26 年）。426 例绝经后女性根据 CTS5 分为以下几类：152 例低风险，139 例中风险和 135 例高风险。LDR 发生率分别为 3.9%、7.2%和 15.6%。CTS5 结果对 LDR 具有预后价值：CTS5 高的患者发生 LDR 的风险是 CTS5 低的患者的四倍（风险比，4.48；95%置信区间，1.80-11.1）。对 177 例绝经前女性进行了相同的分析：88 例低风险，40 例中风险和 49 例高风险。LDR 发生率分别为 5.6%、7.5%和 20.4%，这表明 CTS5 对绝经前患者也具有预后价值（CTS5 高 vs. CTS5 低：风险比，3.40；95%置信区间，1.06-11.0）。
CTS5 显示在我们的真实生活中绝经前和绝经后患者人群中，与 LDR 风险相关。我们的结果支持在临床实践中使用它来更好地定制延长 ET 的处方。
