The 21-Gene Recurrence Score in Clinically High-Risk Lobular and Ductal Breast Cancer: A National Cancer Database Study.
The 21-Gene Recurrence Score in Clinically High-Risk Lobular and Ductal Breast Cancer: A National Cancer Database Study.
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DOI：
10.1245/s10434-022-12065-3
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发表时间：
2022-11
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
本研究的目的是评估浸润性小叶癌（ILC）患者在使用21基因复发评分（RS）时是否比浸润性导管癌（IDC）患者更容易出现不一致的临床和基因组风险，并根据组织学分层评估1-3个淋巴结阳性且RS≤25的患者接受和不接受化疗的总生存结局。我们使用国家癌症数据库进行了一项队列研究，包括激素受体阳性、her2阴性、I-III期浸润性乳腺癌患者，他们接受了21基因RS检测。我们的主要结局是按组织学亚型划分的临床和基因组风险状态不一致的比率。倾向评分匹配用于比较接受和未接受化疗的1-3个阳性淋巴结和RS≤25的个体的60个月总生存率。总的来说，我们的分析纳入了186,867例患者，其中包括37,685例（20.2%）ILC患者。与IDC患者相比，ILC患者的临床和基因组风险不一致率明显更高。在1-3个阳性淋巴结和RS≤25的患者中，在IDC或ILC队列中，接受化疗和未接受化疗的患者的生存率无显著差异。未经调整的探索性分析显示，年龄在50岁以下、1-3个淋巴结阳性且RS≤25的IDC患者接受化疗后总生存率提高，而ILC患者则没有。我们的研究结果强调了小叶特异性工具对临床和基因组风险分层的重要性，以及在随机试验中进行组织学亚型特异性分析的必要性。在线版本包含补充材料，可在10.1245/s10434-022-12065-3获得。
The aim of this study was to evaluate whether patients with invasive lobular carcinoma (ILC) are more likely to have discordant clinical and genomic risk than those with invasive ductal carcinoma (IDC) when using the 21-gene recurrence score (RS), and to assess overall survival outcomes of patients with 1–3 positive nodes and RS ≤25 with and without chemotherapy, stratified by histology. We performed a cohort study using the National Cancer Database and included patients with hormone receptor-positive, HER2-negative, stage I–III invasive breast cancer who underwent 21-gene RS testing. Our primary outcome was rate of discordant clinical and genomic risk status by histologic subtype. Propensity score matching was used to compare 60-month overall survival in individuals with 1–3 positive nodes and RS ≤25 who did and did not receive chemotherapy. Overall, 186,867 patients were included in our analysis, including 37,685 (20.2%) patients with ILC. There was a significantly higher rate of discordant clinical and genomic risk in patients with ILC compared with IDC. Among patients with 1–3 positive nodes and RS ≤25, there was no significant difference in survival between those who did and did not receive chemotherapy in the IDC or ILC cohorts. Unadjusted exploratory analyses of patients under age 50 years with 1–3 positive nodes and RS ≤25 showed improved overall survival in IDC patients who received chemotherapy, but not among those with ILC. Our findings highlight the importance of lobular-specific tools for stratifying clinical and genomic risk, as well as the need for histologic subtype-specific analyses in randomized trials. The online version contains supplementary material available at 10.1245/s10434-022-12065-3.
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DOI：
10.1056/nejmoa1804710
发表时间：
2018-07-12
期刊：
The New England journal of medicine
影响因子：
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作者：
Sparano JA;Gray RJ;Makower DF;Pritchard KI;Albain KS;Hayes DF;Geyer CE Jr;Dees EC;Goetz MP;Olson JA Jr;Lively T;Badve SS;Saphner TJ;Wagner LI;Whelan TJ;Ellis MJ;Paik S;Wood WC;Ravdin PM;Keane MM;Gomez Moreno HL;Reddy PS;Goggins TF;Mayer IA;Brufsky AM;Toppmeyer DL;Kaklamani VG;Berenberg JL;Abrams J;Sledge GW Jr
通讯作者：
Sledge GW Jr
DOI：
10.1056/nejmoa2108873
发表时间：
2021-12-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
45.3
作者：
Bilimoria, Karl Y.;Bentrem, David J.;Ko, Clifford Y.
通讯作者：
Ko, Clifford Y.
影响因子：
45.3
作者：
Ravdin, PM;Siminoff, LA;Parker, HL
通讯作者：
Parker, HL