Lee Jun-Hee, Lee Se Kyung, Chae Byung Joo, Yu Jonghan, Lee Jeong Eon, Kim Seok Won, Nam Seok Jin, Ryu Jai Min
Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Oncol. 2021 Jun 21;11:691277. doi: 10.3389/fonc.2021.691277. eCollection 2021.
Endocrine therapy is administered to hormone-positive breast cancer patients to prevent distant metastasis. It is important to evaluate the risk of recurrence and to determine which patients are viable candidates for such treatment because hormone therapy has side effects that can include postmenopausal symptoms. The Clinical Treatment Score post-five years (CTS5), a simple tool for identifying candidates for endocrine therapy, was recently introduced; however, CTS5 only has been applied in validation studies with postmenopausal women. We aimed to validate CTS5 among premenopausal breast cancer patients.
We identified patients treated between 1994 and 2014 at Samsung Medical Center in Seoul, Korea, and followed their treatment outcomes for more than 60 months after surgery using clinicopathologic parameters. According to menopausal status, we divided the study population into two groups: pre- and postmenopausal women. After calculating CTS5 values based on some parameters, we stratified the rate of late distant recurrence (DR) and analyzed the correlation between CTS5 value and late DR by risk.
Among 16,904 patients treated surgically for breast cancer, 2,605 with hormone receptor-positive breast cancer who received endocrine therapy were included. Of these, 1,749 (67.14%) patients were premenopausal women, and the median age was 44.00 years. When categorizing study participants according to CTS5-related risk for late DR, 86.79% were categorized as low risk, 5.95% were categorized as intermediate risk, and 7.26% were categorized as high risk. The annual rate of DR was 1.41% for those in the present study and was similar between pre- and postmenopausal participants (1.40 vs. 1.42). Distant metastasis-free survival was not different between the two groups (hazard ratio: 0.817, 95% confidence interval [CI]: 0.547-1.221). The area under the receiver operating characteristic curve at 10 years for premenopausal and postmenopausal patients was 61.75 (95% CI: 52.97-70.53) and 72.71 (95% CIs: 63.30-82.12), respectively.
Although CTS5 was able to predict late DR, it should be applied with caution in premenopausal women. A CTS5 calculator for premenopausal women might be needed to not underestimate the risk of recurrence in Korea.
对激素受体阳性乳腺癌患者进行内分泌治疗以预防远处转移。评估复发风险并确定哪些患者适合这种治疗非常重要，因为激素治疗有副作用，可能包括绝经后症状。最近引入了临床治疗5年后评分（CTS5），这是一种用于识别内分泌治疗候选者的简单工具；然而，CTS5仅应用于绝经后女性的验证研究。我们旨在验证绝经前乳腺癌患者中的CTS5。
我们确定了1994年至2014年在韩国首尔三星医疗中心接受治疗的患者，并使用临床病理参数在手术后对其治疗结果进行了60多个月的随访。根据绝经状态，我们将研究人群分为两组：绝经前和绝经后女性。在根据一些参数计算CTS5值后，我们对晚期远处复发（DR）率进行分层，并按风险分析CTS5值与晚期DR之间的相关性。
在16904例接受乳腺癌手术治疗的患者中，纳入了2605例接受内分泌治疗的激素受体阳性乳腺癌患者。其中，1749例（67.14%）患者为绝经前女性，中位年龄为44.00岁。根据与CTS5相关的晚期DR风险对研究参与者进行分类时，86.79%被分类为低风险，5.95%被分类为中度风险，7.26%被分类为高风险。本研究中患者的年DR率为1.41%，绝经前和绝经后参与者之间相似（1.40对1.42）。两组之间的无远处转移生存期无差异（风险比：0.817，95%置信区间[CI]：0.547 - 1.221）。绝经前和绝经后患者10年时的受试者工作特征曲线下面积分别为61.75（95%CI：52.97 - 70.53）和72.71（95%CI：63.30 - 82.12）。
虽然CTS5能够预测晚期DR，但在绝经前女性中应用时应谨慎。可能需要一个针对绝经前女性的CTS5计算器，以免低估韩国患者的复发风险。
