21基因复发评分在预测T1N0期乳腺癌保乳手术后放疗预后获益中的作用

Role of 21-Gene Recurrence Score in Predicting Prognostic Benefit of Radiation Therapy After Breast-Conserving Surgery for T1N0 Breast Cancer.

作者信息

Chevli Neil, Haque Waqar, Tran Kevin T, Farach Andrew M, Schwartz Mary R, Hatch Sandra S, Butler E Brian, Teh Bin S

机构信息

Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas.

Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas.

出版信息

Pract Radiat Oncol. 2023 May-Jun;13(3):e230-e238. doi: 10.1016/j.prro.2022.08.004. Epub 2022 Aug 28.

DOI:10.1016/j.prro.2022.08.004

PMID:36038115

Abstract

PURPOSE

The 21-gene RT-PCR recurrence score (RS) is performed in patients with hormone receptor-positive (ER+, PR+), human epidermal growth factor receptor 2 (HER2)-negative, N0 breast cancer to determine which patients will likely benefit from chemotherapy after breast-conserving surgery (BCS). The purpose of this study was to evaluate whether the RS can predict for patients likely to benefit from radiation therapy (RT) after BCS.

METHODS AND MATERIALS

The National Cancer Database was queried (2004-2017) for female patients with pT1N0 ER+ PR+ HER2-negative breast cancer treated with BCS who had an available RS. Patients were stratified based on their RS (low risk [LR], 1-10; intermediate risk [IR], 11-25; high risk [HR], 26-100). For each RS cohort, propensity score matching was conducted to create 1:1 matched cohorts of patients who received RT and patients who did not. Kaplan-Meier analysis evaluated overall survival (OS). Univariable and multivariable (MVA) Cox proportional hazard analysis identified clinical and treatment factors prognostic for OS.

RESULTS

A total of 79,040 patients met the selection criteria: 18,823 in the LR cohort, 52,341 in the IR cohort, and 7876 in the HR cohort. A total of 92% of patients received RT: 91% in the LR cohort, 93% in the IR cohort, and 92% in the HR cohort. After propensity score matching, the 5-year OS in the LR cohort was 95% for those who received RT and 93% for those who did not (P = .184). In the IR cohort, the 5-year OS was 95% for those who received RT and 93% for those who did not (P = .001). In the HR cohort, the 5-year OS was 95% for those who received RT and 84% for those who did not (P < .001). MVA demonstrated that RT was a positive prognostic factor for OS in both the IR cohort (P = .001) and HR cohort (P < .001). On MVA in the LR cohort, RT (P = .186) was not predictive of improved OS.

CONCLUSIONS

An OS benefit was observed with the use of RT in patients with IR or HR RS but not in patients with LR RS. Future prospective evaluation is warranted.

摘要

目的

对激素受体阳性（ER +、PR +）、人表皮生长因子受体2（HER2）阴性、N0期乳腺癌患者进行21基因逆转录聚合酶链反应复发评分（RS），以确定哪些患者在保乳手术（BCS）后可能从化疗中获益。本研究的目的是评估RS是否可以预测BCS后可能从放射治疗（RT）中获益的患者。

方法和材料

查询国家癌症数据库（2004 - 2017年）中接受BCS治疗且有可用RS的pT1N0 ER + PR + HER2阴性女性乳腺癌患者。根据RS对患者进行分层（低风险[LR]，1 - 10；中风险[IR]，11 - 25；高风险[HR]，26 - 100）。对于每个RS队列，进行倾向评分匹配，以创建接受RT和未接受RT的患者1:1匹配队列。采用Kaplan - Meier分析评估总生存期（OS）。单变量和多变量（MVA）Cox比例风险分析确定OS的预后临床和治疗因素。

结果

共有79,040例患者符合入选标准：LR队列18,823例，IR队列52,341例，HR队列7876例。共有92%的患者接受了RT：LR队列中为91%，IR队列中为93%，HR队列中为92%。倾向评分匹配后，LR队列中接受RT的患者5年OS为95%，未接受RT的患者为93%（P = 0.184）。在IR队列中，接受RT的患者5年OS为95%，未接受RT的患者为93%（P = 0.001）。在HR队列中，接受RT的患者5年OS为95%，未接受RT的患者为84%（P < 0.001）。MVA显示，RT在IR队列（P = 0.001）和HR队列（P < 0.001）中均为OS的阳性预后因素。在LR队列的MVA中，RT（P = 0.186）不能预测OS改善。