Cancer Res Treat.  2019 Oct;51(4):1437-1448. 10.4143/crt.2018.611.

Impact of 21-Gene Recurrence Score on Chemotherapy Decision in Invasive Ductal Carcinoma of Breast with Nodal Micrometastases

• Chen WR
• Deng JP
• Wang J
• Sun JY
• He ZY
• Wu SG

• KMID: 2460593
• DOI: http://doi.org/10.4143/crt.2018.611

Abstract

PURPOSE
The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC).
MATERIALS AND METHODS
Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed.
RESULTS
We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2-negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs.
CONCLUSION
The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.

Keyword

Breast neoplasms; Surgery; Drug therapy

MeSH Terms

Breast Neoplasms
Breast*
Carcinoma, Ductal*
Chemotherapy, Adjuvant
Cohort Studies
Drug Therapy*
Epidermal Growth Factor
Estrogens
Humans
Multivariate Analysis
Neoplasm Micrometastasis*
Prognosis
Recurrence*
Epidermal Growth Factor
Estrogens

Figure

• 

  Fig. 1. The patient selection flowchart of this study. RS, recurrence score; ER, estrogen receptor; PR, progesterone receptor.

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  Fig. 2. The percentage of chemotherapy receipt by 21-gene recurrence score (RS) groups. (A) Traditional RS cutoffs. (B) Trial Assigning Individualized Options for Treatment (TAILORx) RS cutoffs.

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  Fig. 3. The breast cancer-specific survival by 21-gene recurrence score (RS) groups. (A) Traditional RS cutoffs. (B) Trial Assigning Individualized Options for Treatment (TAILORx) RS cutoffs.

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  Fig. 4. The association of chemotherapy with breast cancer-specific survival by 21-gene recurrence score (RS) groups. Traditional RS cutoffs: low-risk (A), intermediate-risk (B), and high-risk (C). Trial Assigning Individualized Options for Treatment (TAILORx) RS cutoffs: low-risk (D), intermediate-risk (E), and high-risk (F).

Reference

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