Xu Ling, Liu Yinhua, Fan Zhimin, Jiang Zefei, Liu Yunjiang, Ling Rui, Zhang Jianguo, Yu Zhigang, Jin Feng, Wang Chuan, Cui Shude, Wang Shu, Mao Dahua, Han Bing, Wang Tao, Zhang Geng, Wang Ting, Guo Baoliang, Yu Lixiang, Xu Yingying, Fu Fangmeng, Liu Zhenzhen, Wang Siyuan, Luo Ke, Xiang Qian, Zhang Zhuo, Liu Qianxin, Zhou Bin, Liu Zhaorui, Ma Chao, Tong Weiwei, Mao Jie, Duan Xuening, Cui Yimin
Breast Disease Center, Peking University First Hospital, Beijing, China.
Department of Breast Surgery, First Hospital of Jilin University, Changchun, China.
Front Oncol. 2021 Mar 16;11:606477. doi: 10.3389/fonc.2021.606477. eCollection 2021.
This study was to assess the prognosis stratification of the clinical-pathologic staging system incorporating estrogen receptor (ER)-negative disease, the nuclear grade 3 tumor pathology (CPS + EG), Neo-Bioscore, and a modified Neo-Bioscore system in breast cancer patients after preoperative systemic therapy (PST). A retrospective multicenter cohort study was conducted from 12 participating hospitals' databases from 2006 to 2015. Five-year disease free survival (DFS), disease specific survival (DSS), and overall survival (OS) were calculated using Kaplan-Meier Method. Area under the curve (AUC) of the three staging systems was compared. Wald test and maximum likelihood estimates in Cox proportional hazards model were used for multivariate analysis. A total of 1,077 patients were enrolled. The CPS + EG, Neo-Bioscore, and modified Neo-Bioscore could all stratify the DFS, DSS, and OS (all P < 0.001). While in the same stratum of Neo-Bioscore scores 2 and 3, the HER2-positive patients without trastuzumab therapy had much poorer DSS (P = 0.013 and P values < 0.01, respectively) as compared to HER2-positive patients with trastuzumab therapy and HER2-negative patients. Only the modified Neo-Bioscore had a significantly higher stratification of 5-year DSS than PS (AUC 0.79 . 0.65, P = 0.03). So, the modified Neo-Bioscore could circumvent the limitation of CPS + EG or Neo-Bioscore.
ClinicalTrials.gov, identifier NCT03437837.
本研究旨在评估在接受术前全身治疗（PST）的乳腺癌患者中，纳入雌激素受体（ER）阴性疾病、核分级3级肿瘤病理（CPS + EG）、Neo-Bioscore以及改良Neo-Bioscore系统的临床病理分期系统的预后分层情况。对2006年至2015年期间12家参与研究医院的数据库进行了一项回顾性多中心队列研究。采用Kaplan-Meier法计算5年无病生存率（DFS）、疾病特异性生存率（DSS）和总生存率（OS）。比较了三种分期系统的曲线下面积（AUC）。在Cox比例风险模型中使用Wald检验和最大似然估计进行多变量分析。共纳入1077例患者。CPS + EG、Neo-Bioscore和改良Neo-Bioscore均可对DFS、DSS和OS进行分层（所有P < 0.001）。在Neo-Bioscore评分为2和3的同一分层中，未接受曲妥珠单抗治疗的HER2阳性患者的DSS比接受曲妥珠单抗治疗的HER2阳性患者和HER2阴性患者差得多（分别为P = 0.013和P值< 0.01）。只有改良Neo-Bioscore的5年DSS分层显著高于PS（AUC 0.79对0.65，P = 0.03）。因此，改良Neo-Bioscore可以规避CPS + EG或Neo-Bioscore的局限性。
ClinicalTrials.gov，标识符NCT03437837。
