Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Breast J. 2021 Jan;27(1):27-34. doi: 10.1111/tbj.14130. Epub 2020 Dec 3.
Among patients with early-stage breast cancer and a high 21-gene recurrence score (RS) ≥ 26, it remains unclear on whether those with RS 26-30 would benefit from chemotherapy with a comparable magnitude as those with RS > 30. In addition, RS > 30 as an independent prognostic factor for breast cancer-specific survival (BCSS) and overall survival (OS) compared to RS 26-30 also remains unclear. The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients diagnosed between 2010 and 2013 with hormone receptor-positive, HER2-negative, and T1-2N0 breast cancer with a RS ≥ 26. Primary end points were OS and BCSS, evaluated by using Kaplan-Meier method, log-rank test, and Cox multivariable analysis. Subgroups of RS 26-30 and RS > 30 were examined using propensity score matching to address selection bias. Among 5054 patients who met the inclusion criteria, adjuvant chemotherapy was associated with improved OS (HR 0.66, 95% CI 0.53-0.83, P < .001) and BCSS (HR 0.61, 95% CI 0.45-0.83, P = .001). In the subgroup of 943 matched pairs of patients with RS 26-30, the addition of chemotherapy remained statistically significant (OS: HR 0.52, 95% CI 0.34-0.79, P = .003; BCSS: HR 0.42, 95% CI 0.22-0.81, P = .009). Among 1194 matched pairs who underwent adjuvant chemotherapy, those with RS > 30 had worse outcomes than others with RS 26-30 (OS: HR 1.68, 95% CI 1.17-2.42, P = .005; BCSS: HR 1.92, 95% CI 1.17-3.15, P = .01). Our study builds on prior literature using a population-based database to suggest the association of adjuvant chemotherapy with improved survival among those with RS 26-30 and worse mortality associated with RS > 30 compared to RS 26-30.
在早期乳腺癌且 21 基因复发评分（RS）≥26 的患者中，RS 为 26-30 的患者是否能从化疗中获益，其获益程度是否与 RS>30 的患者相当，目前仍不清楚。此外，RS>30 作为乳腺癌特异性生存（BCSS）和总生存（OS）的独立预后因素，与 RS 为 26-30 的患者相比，其优势是否也尚不明确。本研究利用监测、流行病学和最终结果（SEER）数据库，检索了 2010 年至 2013 年间确诊的激素受体阳性、HER2 阴性、T1-2N0 乳腺癌且 RS≥26 的患者。主要终点是 OS 和 BCSS，采用 Kaplan-Meier 方法、对数秩检验和 Cox 多变量分析进行评估。使用倾向评分匹配来检查 RS 为 26-30 和 RS>30 的亚组，以解决选择偏倚。在符合纳入标准的 5054 例患者中，辅助化疗可改善 OS（HR 0.66，95%CI 0.53-0.83，P<.001）和 BCSS（HR 0.61，95%CI 0.45-0.83，P=.001）。在 RS 为 26-30 的 943 对匹配患者亚组中，添加化疗仍具有统计学意义（OS：HR 0.52，95%CI 0.34-0.79，P=.003；BCSS：HR 0.42，95%CI 0.22-0.81，P=.009）。在接受辅助化疗的 1194 对匹配患者中，RS>30 的患者比 RS 为 26-30 的患者预后更差（OS：HR 1.68，95%CI 1.17-2.42，P=.005；BCSS：HR 1.92，95%CI 1.17-3.15，P=.01）。本研究基于既往文献，利用基于人群的数据库，表明在 RS 为 26-30 的患者中，辅助化疗与生存改善相关，而 RS>30 的患者与 RS 为 26-30 的患者相比，死亡率更高。
