Ünal Çağlar, Özmen Tolga, Ordu Çetin, Pilanci Kezban Nur, İlgün Ahmet Serkan, Gökmen Erhan, Almuradova Elvina, Özdoğan Mustafa, Güler Nilüfer, Uras Cihan, Kara Halil, Demircan Orhan, Işık Selver, Alço Gül, Saip Pınar, Aydın Esra, Duymaz Tomris, Çelebi Filiz, Yararbaş Kanay, Soybir Gursel, Ozmen Vahit
Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye.
Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA, United States.
Front Oncol. 2023 Jun 28;13:1151733. doi: 10.3389/fonc.2023.1151733. eCollection 2023.
The Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.
Estrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.
A total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.
This first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS.
Oncotype Dx复发评分（ODx-RS）指导早期激素受体阳性、HER-2受体阴性乳腺癌患者的辅助化疗决策过程。本研究旨在评估根据肿瘤专家委员会决策接受辅助治疗的pT1-2、N0-N1mic患者的生存率及其与ODx-RS的相关性。
纳入2010年至2014年间接受手术且已知ODx-RS的雌激素阳性HER-2阴性早期乳腺癌患者（pT1-2 N0、N1mic）。主要目的是根据ODx-RS评估5年无病生存率（DFS）。
本研究共纳入203例符合条件的患者，中位年龄为48岁（范围26-75岁），中位随访时间为84个月（范围23-138个月）。对所有患者的ROC曲线分析显示复发临界年龄为45岁，因此按≤45岁和>45岁对患者进行分组评估。单纯内分泌治疗（ET）组和化疗联合内分泌治疗（CE）组的5年DFS率无显著差异。然而，在ET组中，45岁以上患者的DFS高于≤45岁的患者。按ODx-RS分为0-17和≥18进行分层时，ET组中前一组的DFS显著更高。然而，CE组未观察到此类差异。在ET组中，ODx-RS≥18和绝经状态被确定为影响生存的独立因素，仅ODx-RS≥18对≤45岁患者的DFS有影响。该亚组的ROC曲线分析发现ODx-RS临界值为18。
土耳其的这项首个多中心Oncotype Dx生存分析证明了Oncotype Dx复发评分和年龄在确定早期乳腺癌患者治疗策略中的重要性。作为与文献不同的方法，我们的研究结果表明，对于Oncotype Dx复发评分≥18的年轻患者（≤45岁），在内分泌治疗中加用化疗可提高DFS。
