Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY, 14203, USA.
Jacobs School of Medicine and Biomedical Sciences, University At Buffalo, The State University of New York, 955 Main Street, Buffalo, NY, 14203, USA.
Breast Cancer Res Treat. 2021 Oct;189(3):737-745. doi: 10.1007/s10549-021-06269-6. Epub 2021 Sep 14.
To evaluate the association of various gene expression assays with pathologic complete response (pCR) in the setting of neoadjuvant chemotherapy among patients with breast cancer METHODS: The National Cancer Database (NCDB) was queried for women diagnosed between 2010 and 2017 with stage I-III breast cancer who underwent neoadjuvant chemotherapy and either 21-gene recurrence score (RS) or 70-gene signature (GS). Logistic multivariable analysis (MVA) was performed to identify variables associated with pCR.
A total of 3009 patients met our inclusion criteria. The median follow up was 48.0 months (interquartile range 32.2-66.7 months). On logistic MVA for all patients, those with a high risk from GS (adjusted odds ratio [aOR] 3.23, 95% confidence interval [CI] 1.49-8.13, p = 0.006) or with RS ≥ 31 (aOR 1.99, 95% CI 1.41-2.82, p < 0.001) were more likely to have pCR. When compared to RS ≥ 31, a high risk from GS was not associated with pCR (aOR 1.01, 95% CI 0.75-1.37, p = 0.94). However, among those with favorable hormone receptor status, similar findings were noted, except that those with a high risk group from GS were less likely to have pCR compared to those with RS ≥ 31 (aOR 0.65, 95% CI 0.43-0.96, p = 0.03). When analyses were repeated using a high risk group from RS defined as RS ≥ 26 among those with favorable hormone receptor status, RS ≥ 26 was not associated with pCR when compared to the high risk from GS (aOR 0.74, 0.50-1.07, p = 0.12).
To our knowledge, this is the largest study using a nationwide oncology database suggesting that high recurrence risk groups in both assays were associated with pCR. Among those with favorable hormone receptor status, RS ≥ 31 may be a more selective prognostic marker for pCR.
评估新辅助化疗中，不同基因表达检测与乳腺癌患者病理完全缓解（pCR）之间的关联。
在国家癌症数据库（NCDB）中，检索了 2010 年至 2017 年间接受新辅助化疗且进行 21 基因复发评分（RS）或 70 基因谱（GS）检测的 I-III 期乳腺癌女性患者。采用逻辑多变量分析（MVA）来识别与 pCR 相关的变量。
共纳入 3009 例患者。中位随访时间为 48.0 个月（四分位间距 32.2-66.7 个月）。对所有患者进行逻辑 MVA 分析，GS 高风险组（调整优势比[aOR] 3.23，95%置信区间[CI] 1.49-8.13，p=0.006）或 RS≥31 组（aOR 1.99，95%CI 1.41-2.82，p<0.001）更有可能达到 pCR。与 RS≥31 相比，GS 高风险与 pCR 无相关性（aOR 1.01，95%CI 0.75-1.37，p=0.94）。然而，在激素受体状态良好的患者中，发现了类似的结果，只是 GS 高风险组达到 pCR 的可能性低于 RS≥31 组（aOR 0.65，95%CI 0.43-0.96，p=0.03）。当在激素受体状态良好的患者中，将 RS 高风险定义为 RS≥26 时，再次进行分析，与 GS 高风险组相比，RS≥26 与 pCR 无相关性（aOR 0.74，95%CI 0.50-1.07，p=0.12）。
据我们所知，这是使用全国肿瘤数据库进行的最大规模研究，表明两种检测的高复发风险组与 pCR 相关。在激素受体状态良好的患者中，RS≥31 可能是 pCR 的更具选择性的预后标志物。
