Division of Hematology-Oncology, Upstate Cancer Center, Upstate University Hospital, Syracuse, NY.
Department of Public Health and Preventive Medicine, Upstate University Hospital, Syracuse, NY.
JCO Precis Oncol. 2024 Mar;8:e2300390. doi: 10.1200/PO.23.00390.
Results from the TAILORx trial revealed that the use of adjuvant chemotherapy along with endocrine therapy had no survival advantage in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2-negative (HER2-), node-negative (N0) breast cancer (BC) with an intermediate (11-25) 21-gene recurrence score (RS) in the overall population. However, in patients under age 50 years, adjuvant chemotherapy demonstrated a progression-free survival benefit when the RS ranged from 16-25. We studied this cohort with the population-based national database.
The 2010-2018 National Cancer Database was used to include patients with BC age 18-50 years, N0, M0, RS 16-25, ER+/progesterone receptor±, and HER2-. Patients were divided into two groups on the basis of adjuvant chemotherapy use, and the survival between them was compared.
Adjuvant chemotherapy use was noted in 4,808/15,792 (30.45%) patients. Median RS was 18 and 21 in patients without and with adjuvant chemotherapy, respectively. Factors associated with adjuvant chemotherapy use were higher T stage, poor and moderately differentiated tumors, age <40 years, care at an academic center, Caucasian race, patients undergoing mastectomy, regional lymph node surgery, and radiation therapy. Kaplan-Meier survival at 10 years was better with adjuvant chemotherapy (96.2% 91.6%). Patients without adjuvant chemotherapy had more adverse outcomes (hazard ratio [HR], 1.683 [95% CI, 1.392 to 2.036]; < .0001). Subgroup analysis showed that the benefit was significant in patients with RS scores 21-25 (HR, 1.953 [95% CI, 1.295 to 2.945]), ductal histology (HR, 1.521 [95% CI, 1.092 to 2.118]), Caucasian race (HR, 1.655 [95% CI, 1.180 to 2.322]), and 41-50 years age group (HR, 1.732 [95% CI, 1.244 to 2.411]).
Our study showed an overall survival benefit for adjuvant chemotherapy use in patients with ER-positive, N0 premenopausal BC patients, age less than 50 years, with an intermediate RS score, particularly 21-25.
TAILORx 试验的结果表明，在雌激素受体（ER）阳性、人表皮生长因子受体 2 阴性（HER2-）、淋巴结阴性（N0）乳腺癌（BC）患者中，无论年龄大小，对于 21 基因复发评分（RS）为 11-25 的患者，辅助化疗联合内分泌治疗并不能提高生存率。然而，在年龄小于 50 岁的患者中，当 RS 范围在 16-25 时，辅助化疗显示出无病生存期的获益。我们使用基于人群的全国性数据库对此队列进行了研究。
本研究使用了 2010-2018 年国家癌症数据库，纳入年龄在 18-50 岁、N0、M0、RS 为 16-25、ER+/孕激素受体±、HER2-的 N0 期 ER 阳性、绝经前 BC 患者。根据是否使用辅助化疗将患者分为两组，并比较两组之间的生存情况。
在 15792 例患者中，有 4808 例（30.45%）使用了辅助化疗。无化疗组和化疗组的中位 RS 分别为 18 和 21。与使用辅助化疗相关的因素包括较高的 T 分期、低分化和中分化肿瘤、年龄<40 岁、在学术中心接受治疗、白种人、接受乳房切除术、区域淋巴结手术和放疗。10 年时，辅助化疗组的生存情况更好（96.2%比 91.6%）。未接受辅助化疗的患者有更多的不良结局（风险比[HR]，1.683[95%可信区间，1.392 至 2.036]；<0.0001）。亚组分析显示，在 RS 评分 21-25（HR，1.953[95%可信区间，1.295 至 2.945]）、导管组织学（HR，1.521[95%可信区间，1.092 至 2.118]）、白种人（HR，1.655[95%可信区间，1.180 至 2.322]）和 41-50 岁年龄组（HR，1.732[95%可信区间，1.244 至 2.411]）中，辅助化疗的生存获益更显著。
本研究表明，对于 ER 阳性、N0 期绝经前 BC 患者，年龄<50 岁，RS 评分中等（16-25），尤其是 RS 评分 21-25 的患者，使用辅助化疗可带来总体生存获益。
