基于第 8 版 AJCC 预后分期的 Oncotype DX 复发评分在 TNM 雌激素受体阳性 HER2 阴性乳腺癌中的预后意义。
The Prognostic Significance of the Oncotype DX Recurrence Score in TNM Estrogen Receptor-Positive HER2-Negative Breast Cancer Based on the Prognostic Stage in the Updated AJCC 8th Edition.
机构信息
Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
出版信息
Ann Surg Oncol. 2019 May;26(5):1227-1235. doi: 10.1245/s10434-018-7068-3. Epub 2018 Nov 19.
BACKGROUND
This study aimed to evaluate the prognostic significance of the Oncotype DX recurrence score (RS) in TNM estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer based on the prognostic stage in the updated American Joint Commission on Cancer, 8th edition.
METHODS
The Surveillance, Epidemiology, and End Results database was searched to identify ER-positive invasive ductal breast cancer in TNM with RS results diagnosed between 2004 and 2012. Patients with RS were categorized into low-risk (RS < 11), intermediate-risk (RS 11-25), and high-risk (RS > 25) groups. The distributions of clinical-pathological characteristics were compared among the RS risk groups using Pearson's Chi square. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared across RS groups using the log-rank statistic. Cox models were fitted to assess the factors independently associated with survival.
RESULTS
The study enrolled 4059 cases categorized into prognostic stages IA to IIB. The RS risk groups were positively correlated with pathological prognostic stages (P < 0.001). The RS risk groups differed significantly in terms of BCSS and OS (P < 0.001). According to the multivariate analysis, RS risk group was an independent prognostic factor for BCSS and OS together with the pathological prognostic stage. The subgroup analysis showed similar survival rates across pathological prognostic stages in the RS low-risk group but significant differences in survival rates among pathological prognostic stages in the RS intermediate-risk group. The survival rates among the RS risk groups also differed significantly in pathological prognostic stage IA.
CONCLUSIONS
Oncotype DX RS provided independent prognostic significance to complement the prognostic staging system.
背景
本研究旨在评估 Oncotype DX 复发评分（RS）在基于第 8 版美国联合癌症委员会更新的预后分期的 TNM 雌激素受体（ER）阳性、人表皮生长因子受体 2（HER2）阴性乳腺癌中的预后意义。
方法
通过搜索监测、流行病学和最终结果数据库，确定 2004 年至 2012 年间诊断为 TNM 伴 RS 结果的 ER 阳性浸润性导管乳腺癌患者。将 RS 患者分为低危（RS<11）、中危（RS 11-25）和高危（RS>25）组。采用 Pearson's Chi square 比较 RS 风险组之间的临床病理特征分布。采用 Kaplan-Meier 法估计乳腺癌特异性生存（BCSS）和总生存（OS），采用对数秩检验比较 RS 风险组之间的生存情况。采用 Cox 模型评估与生存相关的独立因素。
结果
研究共纳入 4059 例分为 IA 至 IIB 期的患者。RS 风险组与病理预后分期呈正相关（P<0.001）。RS 风险组在 BCSS 和 OS 方面存在显著差异（P<0.001）。多因素分析显示，RS 风险组与病理预后分期一起是 BCSS 和 OS 的独立预后因素。亚组分析显示，RS 低危组在病理预后分期中生存曲线相似，但 RS 中危组在病理预后分期中生存曲线存在显著差异。RS 风险组在病理预后分期 IA 中也存在显著的生存差异。
结论
Oncotype DX RS 提供了独立的预后意义，以补充预后分期系统。
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