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比较 Nottingham 预后指数和 OncotypeDX© 复发评分在预测雌激素受体阳性乳腺癌患者预后中的作用。

Comparison of the Nottingham Prognostic Index and OncotypeDX© recurrence score in predicting outcome in estrogen receptor positive breast cancer.

机构信息

Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland.

Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland.

出版信息

Breast. 2022 Dec;66:227-235. doi: 10.1016/j.breast.2022.11.001. Epub 2022 Nov 3.

DOI:10.1016/j.breast.2022.11.001
PMID:36335747
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9647009/
Abstract

INTRODUCTION

Traditionally, Nottingham prognostic index (NPI) informed prognosis in patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative, node negative (ER+/HER2-/LN-) breast cancer. At present, OncotypeDX© Recurrence Score (RS) predicts prognosis and response to adjuvant chemotherapy (AC).

AIMS

To compare NPI and RS for estimating prognosis in ER + breast cancer.

METHODS

Consecutive patients with ER+/HER2-/LN- disease were included. Disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier and Cox regression analyses.

RESULTS

1471 patients met inclusion criteria. The mean follow-up was 110.7months. NPI was calculable for 1382 patients: 19.8% had NPI≤2.4 (291/1471), 33.0% had NPI 2.41-3.4 (486/1471), 30.0% had NPI 3.41-4.4 (441/1471), 10.9% had NPI 4.41-5.4 (160/1471), and 0.3% had NPI>5.4 (4/1471). In total, 329 patients underwent RS (mean RS: 18.7) and 82.1% had RS < 25 (270/329) and 17.9% had RS ≥ 25 (59/329). Using multivariable Cox regression analyses (n = 1382), NPI independently predicted DFS (Hazard ratio (HR): 1.357, 95% confidence interval (CI): 1.140-1.616, P < 0.001) and OS (HR: 1.003, 95% CI: 1.001-1.006, P = 0.024). When performing a focused analysis of those who underwent both NPI and RS (n = 329), neither biomarker predicted DFS or OS. Using Kaplan Meier analyses, NPI category predicted DFS (P = 0.008) and (P = 0.026) OS. Conversely, 21-gene RS group failed to predict DFS (P = 0.187) and OS (P = 0.296).

CONCLUSION

In our focused analysis, neither NPI nor RS predicted survival outcomes. However, in the entire series, NPI independently predicted both DFS and OS. On the 40th anniversary since its derivation, NPI continues to provide accurate prognostication in breast cancer, outperforming RS in the current study.

摘要

简介

传统上，诺丁汉预后指数（NPI）用于预测雌激素受体阳性、人表皮生长因子受体 2 阴性、淋巴结阴性（ER+/HER2-/LN-）乳腺癌患者的预后。目前，OncotypeDX©复发评分（RS）可预测预后和辅助化疗（AC）的反应。

目的

比较 NPI 和 RS 以估计 ER+乳腺癌的预后。

方法

连续纳入 ER+/HER2-/LN-疾病患者。使用 Kaplan-Meier 和 Cox 回归分析确定无病生存（DFS）和总生存（OS）。

结果

1471 例患者符合纳入标准。中位随访时间为 110.7 个月。可计算 1382 例患者的 NPI：19.8%的患者 NPI≤2.4（291/1471），33.0%的患者 NPI 2.41-3.4（486/1471），30.0%的患者 NPI 3.41-4.4（441/1471），10.9%的患者 NPI 4.41-5.4（160/1471），0.3%的患者 NPI>5.4（4/1471）。共有 329 例患者接受了 RS（平均 RS：18.7），82.1%的患者 RS<25（270/329），17.9%的患者 RS≥25（59/329）。使用多变量 Cox 回归分析（n=1382），NPI 独立预测 DFS（危险比（HR）：1.357，95%置信区间（CI）：1.140-1.616，P<0.001）和 OS（HR：1.003，95%CI：1.001-1.006，P=0.024）。当对同时接受 NPI 和 RS 检查的患者（n=329）进行重点分析时，两种生物标志物均未预测 DFS 或 OS。使用 Kaplan-Meier 分析，NPI 类别预测 DFS（P=0.008）和 OS（P=0.026）。相反，21 基因 RS 组未能预测 DFS（P=0.187）和 OS（P=0.296）。

结论

在我们的重点分析中，NPI 和 RS 均未预测生存结果。然而，在整个系列中，NPI 独立预测了 DFS 和 OS。在其推导 40 周年之际，NPI 继续在乳腺癌中提供准确的预后，在本研究中表现优于 RS。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/d18dede8ac44/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/cc1c1b7b8acb/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/8a78e1f48219/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/565efe3a9bd0/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/d18dede8ac44/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/cc1c1b7b8acb/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/8a78e1f48219/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/565efe3a9bd0/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa6/9647009/d18dede8ac44/gr4.jpg

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