IEO, Istituto Europeo di Oncologia IRCCS, Milan, Italy; Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milan, Italy.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Eur J Cancer. 2022 Mar;164:52-61. doi: 10.1016/j.ejca.2022.01.003. Epub 2022 Feb 15.
Molecular tests predicting the risk of distant recurrence (DR) can be used to assist therapy decision-making in oestrogen receptor-positive (ER+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer patients after considerations of standard clinical markers. The Oncotype DX Recurrence Score (RS) is a widespread tool used for this purpose. Here, we compared the RS with the StemPrintER Risk Score (SPRS), a novel genomic predictor with a unique biological basis in its ability to measure the expression of cancer stemness genes.
We benchmarked the SPRS vs. RS, alone or in combination with clinicopathological variables expressed by the Clinical Treatment Score (CTS), for the prognostication of DR in a retrospective cohort of 776 postmenopausal patients with ER+/HER2-breast cancer enrolled in the translational arm of the randomised Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial. Likelihood ratio (LR) with χ test and C-index were used to assess prognostic performance for the entire ten-year follow-up period and in early (0-5 years) and late (5-10 years) intervals.
In all patients, the SPRS provided significantly more prognostic information than the RS for ten-year DR prognostication (C-index = 0.688, LR-χ = 33.4 vs. C-index = 0.641, LR-χ = 22.1) and for late (5-10 years) DR prognostication (C-index = 0.689, LR-χ = 18.8 vs. C-index = 0.571, LR-χ = 4.7). The SPRS also provided more prognostic information than the RS when added to the CTS in all patients (CTS + SPRS: LR-Δχ = 14.9; CTS + RS: LR-Δχ = 9.7) and in node-negative patients (CTS + SPRS: LR-Δχ = 11.7; CTS + RS: LR-Δχ = 6.6).
In postmenopausal ER+/HER2- breast cancer patients, SPRS provided more prognostic information than RS for DR when used alone or in combination with the CTS. The SPRS could therefore potentially identify high-risk patients, who might benefit from aggressive treatments, from low-risk patients who might safely avoid adjuvant chemotherapy or prolongation of endocrine therapy.
分子检测可预测远处复发（DR）风险，有助于雌激素受体阳性（ER+）和人表皮生长因子受体 2 阴性（HER2-）乳腺癌患者在考虑标准临床标志物后做出治疗决策。Oncotype DX 复发评分（RS）是一种广泛使用的工具。在此，我们比较了 RS 与 StemPrintER 风险评分（SPRS），后者是一种新型基因组预测指标，其独特的生物学基础在于能够测量癌症干性基因的表达。
我们在随机 Arimidex、他莫昔芬、单独或联合（ATAC）试验的转化臂中纳入的 776 例绝经后 ER+/HER2-乳腺癌患者的回顾性队列中，比较了 SPRS 与 RS 单独或与临床治疗评分（CTS）联合用于预测 DR 的预后，CTS 可表达临床病理变量。采用似然比（LR）检验和 C 指数评估整个 10 年随访期以及早期（0-5 年）和晚期（5-10 年）的预后性能。
在所有患者中，SPRS 在预测 10 年 DR 方面提供了比 RS 更显著的预后信息（C 指数=0.688，LR-χ=33.4 vs. C 指数=0.641，LR-χ=22.1），在预测晚期（5-10 年）DR 方面提供了更显著的预后信息（C 指数=0.689，LR-χ=18.8 vs. C 指数=0.571，LR-χ=4.7）。当 SPRS 与 CTS 联合使用时，SPRS 也为所有患者（CTS+SPRS：LR-Δχ=14.9；CTS+RS：LR-Δχ=9.7）和淋巴结阴性患者（CTS+SPRS：LR-Δχ=11.7；CTS+RS：LR-Δχ=6.6）提供了比 RS 更多的预后信息。
在绝经后 ER+/HER2-乳腺癌患者中，SPRS 单独或与 CTS 联合使用时，可为 DR 提供比 RS 更多的预后信息。因此，SPRS 可能有助于确定高危患者，他们可能受益于强化治疗，同时避免低危患者接受辅助化疗或延长内分泌治疗。
