21 基因复发评分在预测保乳术后 T1-2N1 腔面型乳腺癌术后放疗结局中的作用。

21-gene recurrence score in predicting the outcome of postoperative radiotherapy in T1-2N1 luminal breast cancer after breast-conserving surgery.

机构信息

Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen, 361005, People's Republic of China.

Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China.

出版信息

Breast. 2024 Apr;74:103679. doi: 10.1016/j.breast.2024.103679. Epub 2024 Feb 12.

DOI:10.1016/j.breast.2024.103679

PMID:38367283

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10882169/

Abstract

BACKGROUND

In those with one to three positive lymph nodes (N1) breast cancer (BC), the 21-gene recurrence score (RS) classification can be referred for decision-making on adjuvant chemotherapy. This study aimed to investigate the effect of RS in predicting the survival benefit of postoperative radiotherapy (PORT) in T1-2N1 BC with estrogen receptor-positive and human epidermal growth factor receptor 2-negative disease after breast-conserving surgery (BCS).

METHODS

We included patients with BC and available RS data from the Surveillance, Epidemiology, and End Results Oncotype DX database. The chi-square test, Kaplan-Meier method, propensity score matching (PSM) as well as multivariable Cox proportional hazard analyses were used for statistical analyses.

RESULTS

We included 6509 patients in the analysis. Of these patients, 5302 (85.5%) were treated with BCS + PORT, and 207 (15.5%) had BCS alone. There were 1419 (21.8%), 4319 (66.4%), and 771 (11.8%) patients being low-, intermediate-, and high-risk RS, respectively. After PSM, PORT was significantly associated with a 5-year overall survival (OS) advantage (95.1% vs. 90.5%, P < 0.001) compared to those without PORT, which similar breast cancer-specific survival (BCSS) was found between the treatment arms (P = 0.126). The sensitivity analyses showed that PORT was not associated with a better BCSS (P = 0.472) and OS (P = 0.650) than those without PORT in the low-risk RS cohort. However, PORT was associated with a better BCSS (P = 0.031) and OS (P < 0.001) compared to those without PORT in the intermediate/high-risk RS cohorts.

CONCLUSIONS

Our study highlights the possible role of the RS in predicting the outcome of PORT in T1-2N1 luminal BC patients undergoing BCS.

摘要

背景

在患有 1 至 3 个阳性淋巴结（N1）的乳腺癌（BC）患者中，可以参考 21 基因复发评分（RS）分类来决定是否接受辅助化疗。本研究旨在探讨 RS 在预测经保乳手术后（BCS）T1-2N1 雌激素受体阳性和人表皮生长因子受体 2 阴性疾病的 BC 患者术后放疗（PORT）生存获益中的作用。

方法

我们纳入了来自监测、流行病学和最终结果 Oncotype DX 数据库的具有 BC 和可用 RS 数据的患者。使用卡方检验、Kaplan-Meier 方法、倾向评分匹配（PSM）以及多变量 Cox 比例风险分析进行统计学分析。

结果

我们纳入了 6509 例患者进行分析。其中，5302 例（85.5%）接受了 BCS+PORT 治疗，207 例（15.5%）仅接受了 BCS。低风险 RS、中风险 RS 和高风险 RS 患者分别为 1419 例（21.8%）、4319 例（66.4%）和 771 例（11.8%）。经 PSM 后，PORT 与 5 年总生存（OS）优势显著相关（95.1% vs. 90.5%，P<0.001），与未接受 PORT 的患者相比，差异有统计学意义，而在治疗组之间，乳腺癌特异性生存（BCSS）相似（P=0.126）。敏感性分析显示，在低风险 RS 队列中，PORT 与未接受 PORT 的患者相比，BCSS（P=0.472）和 OS（P=0.650）无显著差异。然而，在中/高危 RS 队列中，PORT 与未接受 PORT 的患者相比，BCSS（P=0.031）和 OS（P<0.001）有显著差异。