Department of Breast Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen, China.
Front Endocrinol (Lausanne). 2023 Feb 16;14:1103949. doi: 10.3389/fendo.2023.1103949. eCollection 2023.
To assess the practice patterns of the recurrence score (RS) based on the 21-gene expression assay on adjuvant chemotherapy recommendations and survival outcomes in estrogen receptor-positive (ER+)/HER2- breast cancer (BC) with one to three positive lymph nodes (N1).
We included patients with T1-2N1M0 and ER+/HER2- BC diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results Oncotype DX Database. Breast cancer-specific survival (BCSS) and overall survival (OS) were assessed.
We included 35,137 patients in this study. There were 21.2% of patients who had RS testing in 2010, which was significantly increased to 36.8% in 2015 (P < 0.001). Performance of the 21-gene testing was associated with older age, lower tumor grade, T1 stage, lower number of positive lymph nodes, and progesterone receptor-positive disease (all P < 0.05). In those without 21-gene testing, age was the main factor significantly related to the receipt of chemotherapy, whereas RS was the main factor significantly related to chemotherapy receipt in those with 21-gene testing. The probability of chemotherapy receipt in those without 21-gene testing was 64.1% and was decreased to 30.8% in those with 21-gene testing. On multivariate prognostic analysis, the performance of 21-gene testing was associated with better BCSS (P < 0.001) and OS (P < 0.001) compared with those without 21-gene testing. Similar results were found after propensity score matching.
The 21-gene expression assay is frequently and increasingly used for chemotherapy decision-making in ER+/HER2- BC with N1 disease. Performance of the 21-gene testing is associated with improved survival outcomes. Our study supports the routine use of 21-gene testing in the clinical practice of this population.
评估基于 21 基因表达检测的复发评分（RS）在雌激素受体阳性（ER+）/人表皮生长因子受体 2 阴性（HER2-）伴 1 至 3 个阳性淋巴结（N1）的乳腺癌（BC）辅助化疗推荐和生存结果中的应用模式。
我们纳入了 2010 年至 2015 年间在监测、流行病学和最终结果（SEER）Oncotype DX 数据库中诊断为 T1-2N1M0 且 ER+/HER2-的 BC 患者。评估了乳腺癌特异性生存（BCSS）和总生存（OS）。
本研究共纳入 35137 例患者。2010 年有 21.2%的患者进行了 RS 检测，而 2015 年则显著增加至 36.8%（P < 0.001）。21 基因检测的表现与年龄较大、肿瘤分级较低、T1 期、阳性淋巴结数较少以及孕激素受体阳性疾病相关（均 P < 0.05）。在未进行 21 基因检测的患者中，年龄是与接受化疗显著相关的主要因素，而在进行 21 基因检测的患者中，RS 是与化疗相关的主要因素。在未进行 21 基因检测的患者中，接受化疗的概率为 64.1%，而在进行 21 基因检测的患者中，这一概率下降至 30.8%。在多因素预后分析中，与未进行 21 基因检测的患者相比，进行 21 基因检测与更好的 BCSS（P < 0.001）和 OS（P < 0.001）相关。倾向评分匹配后也得到了相似的结果。
21 基因表达检测常用于 ER+/HER2-伴 N1 疾病的 BC 患者的化疗决策，且 21 基因检测的表现与改善的生存结果相关。我们的研究支持在该人群的临床实践中常规使用 21 基因检测。
