Shrestha Amber, Cullinane Carolyn, Evoy Denis, Geraghty James, Rothwell Jane, Walshe Janice, McCartan Damien, McDermott Enda, Prichard Ruth
Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland.
Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland.
Br J Surg. 2022 Apr 19;109(5):411-417. doi: 10.1093/bjs/znac008.
The Clinical Treatment Score post-5 years (CTS5) integrates four clinicopathological variables to estimate the residual disease recurrence risk in hormone receptor-positive breast cancer patients who have been treated with five years of adjuvant endocrine therapy. This study aimed to determine the accuracy of the CTS5.
A systematic review was performed in accordance with the PRISMA statement. Studies relevant for inclusion in the current review were identified from The Cochrane Library, EBSCO, Ovid, PubMed, and Embase.
Six papers reported on 30 354 postmenopausal patients (age range 42 to 91 years). The pooled hazard ratio (HR) of distant recurrence relative to the low-risk CTS5 category was 5.41 (95% c.i. 4.50 to 6.51; P < 0.05) for the high-risk CTS5 category and 2.32 (95% c.i. 1.90-2.84; P < 0.05) for the intermediate CTS5 category. Three papers reported on 10 425 premenopausal patients (age range 18 to 54 years). The pooled HR of distant recurrence relative to the low-risk CTS5 category was 5.42 (95% c.i. 2.26 to 13.01; P < 0.05) for the high-risk CTS5 category and 2.82 (95% c.i. 1.35 to 5.88; P < 0.05) for the intermediate CTS5 category. Relative to high-risk postmenopausal patients, the mean observed 10-year distant recurrence risk for the high CTS5 category was 13.83 per cent, which differs significantly from the CTS5 estimation of 10-year distant recurrence risk (20.3 per cent, 95% c.i. 17.2 to 24; P = 0.000).
The CTS5 can predict late distant recurrence risk in pre- and postmenopausal hormone receptor-positive breast cancer patients. CTS5 overestimates the risk for high-risk patients and thus, its use in these patients warrants caution.
5年后临床治疗评分（CTS5）整合了四个临床病理变量，以评估接受5年辅助内分泌治疗的激素受体阳性乳腺癌患者的残留疾病复发风险。本研究旨在确定CTS5的准确性。
按照PRISMA声明进行系统评价。从Cochrane图书馆、EBSCO、Ovid、PubMed和Embase中识别出与纳入本综述相关的研究。
六篇论文报道了30354名绝经后患者（年龄范围42至91岁）。高危CTS5类别相对于低危CTS5类别的远处复发合并风险比（HR）为5.41（95%可信区间4.50至6.51；P<0.05），中危CTS5类别为2.32（95%可信区间1.90 - 2.84；P<0.05）。三篇论文报道了10425名绝经前患者（年龄范围18至54岁）。高危CTS5类别相对于低危CTS5类别的远处复发合并HR为5.42（95%可信区间2.26至13.01；P<0.05），中危CTS5类别为2.82（95%可信区间1.35至5.88；P<0.05）。相对于高危绝经后患者，CTS5高危类别10年远处复发的平均观察风险为13.83%，这与CTS5对10年远处复发风险的估计（20.3%，95%可信区间17.2至24；P = 0.000）有显著差异。
CTS5可以预测绝经前和绝经后激素受体阳性乳腺癌患者的晚期远处复发风险。CTS5高估了高危患者的风险，因此，在这些患者中使用时应谨慎。
