【Abstract】
Background: The 21-gene recurrence score (RS) assay has been proven prognostic and predictive for hormone receptor-positive/HER2-negative, node-negative early breast cancer patients. However, whether primary 21-gene RS can predict prognosis in recurrent breast cancer patients remained unknown.
Patients and methods: Consecutive breast cancer patients operated in Comprehensive Breast Health Center, Shanghai Ruijin Hospital between January 2009 and December 2018 were retrospectively analyzed. Patients with available 21-gene RS result for the primary tumor and reporting disease recurrence during follow-up were included. Association of 21-gene RS and overall survival (OS), post-recurrence overall survival (PR-OS), post-recurrence progression-free survival (PR-PFS), and first-line systemic treatment after recurrence were compared among different groups.
Results: A total of 74 recurrent patients were included, with 10, 27, 37 patients in the RS < 18, 18-30 and ≥ 31 groups, respectively. Recurrent patients with RS ≥ 31 were more likely to receive chemotherapy as their first-line treatment compared to those with RS < 31 (P = 0.025). Compared to those with RS < 31, patients with RS ≥ 31 had significantly worse OS (P = 0.025), worse PR-OS (P = 0.026), and a trend of inferior PR-PFS (P = 0.106). Multivariate analysis demonstrated that primary ER expression level (OS: P = 0.009; PR-OS: P = 0.017) and histological grade (OS: P = 0.003; PR-OS: P = 0.009), but not primary 21-gene RS (OS: P = 0.706; PR-OS: P = 0.120), were independently associated with worse OS and PR-OS.
Conclusions: High primary 21-gene RS tended to be associated with worse disease outcome in loco-regional and distant recurrent breast cancer patients, which could influence the first-line systemic treatment after relapse, warranting further clinical evaluation.
【中文摘要】
背景：21基因復發分數（Recurrence score, RS）是乳腺癌治療中廣泛應用的多基因陣列，對於激素受體陽性/ HER2陰性、淋巴結陰性的早期乳腺癌患者，可預測其疾病預後及輔助化療的獲益。然而，對於經過標準治療後發生復發轉移的患者，原發灶RS是否仍能預測患者預後、指導全身治療，目前尚不明確。
方法：本研究回顧性納入2009年1月至2018年12月於瑞金醫院乳腺疾病診治中心接受手術、接受原發灶RS檢測、在隨訪期間出現乳腺癌局部區域復發或遠處轉移的患者，根據原發灶RS分為低危（RS <18）、中危（RS 18-30）和高危（RS≥31）組。比較各組患者總生存期（Overall survival, OS）、復發後總生存期（Post-recurrence overall survival, PR-OS）、復發後無進展生存期（Post-recurrence progression-free survival, PR-PFS）及各組復發轉移後一線全身治療決策的差異。
結果：本研究最終納入74例復發轉移性乳腺癌患者，其中低、中、高危組分別有10、27、37人。復發轉移後，原發灶高危組患者一線接受化療的比例顯著高於原發灶低、中危組（P = 0.025）。Kaplan-Meier生存曲線提示原發灶高危組患者的OS（P = 0.025）和PR-OS（P = 0.026）顯著劣於原發灶低、中危組患者。多因素分析顯示，原發灶雌激素受體低表達（OS：P = 0.009; PR-OS：P = 0.017）和組織學分級III級（OS：P = 0.003; PR-OS：P = 0.009）是復發轉移性乳腺癌患者不良預後的獨立預測因素，但原發灶RS（OS：P = 0.706；PR-OS：P = 0.120）無法獨立預測預後。
結論：復發轉移性乳腺癌患者中，原發灶RS高危可能提示不良預後。原發灶RS影響復發後一線全身治療策略，有待進一步臨床研究數據的佐證。