Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA.
Ann Surg Oncol. 2023 Dec;30(13):8335-8343. doi: 10.1245/s10434-023-14155-2. Epub 2023 Sep 7.
The 21-gene recurrence score (RS) is used to predict benefit from chemotherapy in hormone receptor (HR)-positive breast cancer with one to three positive lymph nodes. Prospective-retrospective studies have shown that the RS is prognostic for both systemic and locoregional recurrence in tamoxifen-treated patients. We aimed to assess whether RS could be utilized to predict a survival benefit from postmastectomy radiation therapy (PMRT).
The National Cancer Database (NCDB) was used to identify women ≤ 75 years of age with HR+, HER2-negative, T1-3, N1, M0 breast cancer who underwent mastectomy and axillary staging with available RS during the years 2010-2016. Kaplan-Meier and Cox proportional hazards models were used to identify association between treatment and overall survival (OS). Univariate and multivariate analyses were used to identify variables correlating with PMRT and OS.
A total of 8907 patients were identified. Of the total, 3203 (36%) patients received adjuvant PMRT and 5704 (64%) did not. Across the entire cohort, 5-year OS was 97.5% for patients receiving PMRT and 96.8% for those who did not (P = 0.063). After adjusting for all covariates, in patients with RS ≤ 25, there was no statistically significant improvement in 5-year OS with the addition of adjuvant PMRT (97.5% versus 98.1% P = 0.093). Moreover, no survival benefit was seen with axillary node dissection (P = 0.58) or with the addition of chemotherapy (P = 0.312).
In our cohort of patients with one to three positive nodes and a RS ≤ 25, omission of post-mastectomy radiation therapy had no impact on OS. Our results suggest that RS may be utilized in the individualized decision making on PMRT.
21 基因复发评分（RS）用于预测激素受体（HR）阳性、淋巴结 1-3 个阳性的乳腺癌患者接受化疗的获益。前瞻性回顾性研究表明，RS 对接受他莫昔芬治疗的患者的全身和局部区域复发均具有预后价值。我们旨在评估 RS 是否可用于预测乳腺癌根治术后放疗（PMRT）的生存获益。
本研究使用国家癌症数据库（NCDB），确定了 2010 年至 2016 年期间年龄≤75 岁、HR+、HER2 阴性、T1-3、N1、M0 乳腺癌、接受乳腺癌根治术和腋窝分期且可获得 RS 的女性患者。采用 Kaplan-Meier 和 Cox 比例风险模型确定治疗与总生存（OS）之间的关联。采用单变量和多变量分析确定与 PMRT 和 OS 相关的变量。
共确定了 8907 例患者。其中，3203 例（36%）患者接受了辅助性 PMRT，5704 例（64%）患者未接受。在整个队列中，接受 PMRT 的患者 5 年 OS 为 97.5%，未接受 PMRT 的患者为 96.8%（P=0.063）。在校正所有协变量后，在 RS≤25 的患者中，加用辅助性 PMRT 并不能显著提高 5 年 OS（97.5%对 98.1%，P=0.093）。此外，腋窝淋巴结清扫术（P=0.58）或加用化疗（P=0.312）均不能带来生存获益。
在我们的队列中，淋巴结 1-3 个阳性且 RS≤25 的患者中，省略 PMRT 对 OS 没有影响。我们的结果表明，RS 可用于个体化决策 PMRT。
