肿瘤复发评分对 AJCC 预后分期系统在 III 期雌激素受体阳性/人表皮生长因子受体 2 阴性乳腺癌中的附加预后价值。
The Added Prognostic Value of Oncotype Recurrence Score to AJCC Prognostic Staging System in Stage III ER+/HER2- Breast Cancer.
作者信息
Wang Maoli, Zhang Mingdi, Chen Hongliang
机构信息
Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China.
出版信息
Adv Ther. 2023 Sep;40(9):3912-3925. doi: 10.1007/s12325-023-02566-2. Epub 2023 Jun 29.
INTRODUCTION
Prognostic prediction based on prognostic stage (PS) with the Oncotype DX recurrence score (RS) has not been validated in stage III ER+/HER2- breast cancer. This study aimed to evaluate the added prognostic significance of RS incorporated with the PS system and to compare the prognostic prediction improvement with anatomic TNM stage (AS) using nomogram construction.
METHODS
The SEER database was indexed to identify ER+/HER2- invasive ductal or lobular breast cancer in AS IIIA-IIIC with RS results diagnosed from 2004 to 2013. Patients with RS < 18, 18-30 and > 30 were categorized into low-, intermediate- and high-risk RS groups. Comparisons of the distribution of clinical-pathologic characteristics among RS risk groups were performed using Pearson's chi-square test. Breast cancer-specific survival (BCSS) was estimated using the Kaplan-Meier method and compared across RS or PS by log-rank test. Cox regression was used to evaluate the factors independently related to BCSS. A nomogram comprised of PS and RS was constructed with discrimination, calibration and clinical benefit evaluated.
RESULTS
Altogether 629 patients who received RS were enrolled. There were 326 cases (51.8%) with low-risk RS, 237 (37.7%) with intermediate-risk RS and 66 (10.5%) with high-risk RS; 344 patients (54.7%) had PS IB, 84 (13.4%) had IIB, 150 (23.8%) had IIIA, 46 (7.3%) had IIIB, and only 5 had (0.8%) IIIC. Both PS and RS were independent prognostic factors for BCSS. There were significant or trends of differences in survival among RS within subtypes stratified by PS. There were significant differences in survival among PS only within intermediate-risk RS. A nomogram prediction 5-year BCSS was constructed with a c-index of 0.811. Lower histologic grade, positive PR and fewer positive lymph nodes were independently correlated with low-risk RS.
CONCLUSION
PS incorporated with RS had improved prognostic significance for stage III ER+/HER 2- breast cancer.
引言
基于预后分期（PS）和Oncotype DX复发评分（RS）进行预后预测，在III期雌激素受体阳性/人表皮生长因子受体2阴性（ER+/HER2-）乳腺癌中尚未得到验证。本研究旨在评估RS纳入PS系统后增加的预后意义，并通过构建列线图比较其与解剖学TNM分期（AS）相比在预后预测方面的改善情况。
方法
检索监测、流行病学和最终结果（SEER）数据库，以识别2004年至2013年诊断为AS IIIA-IIIC期且有RS结果的ER+/HER2-浸润性导管癌或小叶癌患者。RS＜18、18-30和＞30的患者分别被分为低、中、高风险RS组。使用Pearson卡方检验比较RS风险组之间临床病理特征的分布。采用Kaplan-Meier法估计乳腺癌特异性生存（BCSS），并通过对数秩检验在RS或PS之间进行比较。采用Cox回归评估与BCSS独立相关的因素。构建由PS和RS组成的列线图，并评估其区分度、校准度和临床获益情况。
结果
共纳入629例接受RS检测的患者。低风险RS患者326例（51.8%），中风险RS患者237例（37.7%），高风险RS患者66例（10.5%）；344例患者（54.7%）为PS IB期，84例（13.4%）为IIB期，150例（23.8%）为IIIA期，46例（7.3%）为IIIB期，仅5例（0.8%）为IIIC期。PS和RS均为BCSS的独立预后因素。在按PS分层的亚型中，RS组之间的生存存在显著差异或趋势。仅在中风险RS组内，PS组之间的生存存在显著差异。构建了一个5年BCSS列线图预测模型，其c指数为0.811。较低的组织学分级、孕激素受体（PR）阳性和较少的阳性淋巴结与低风险RS独立相关。
结论
PS结合RS对III期ER+/HER2-乳腺癌具有更好的预后意义。
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