Prognostic utility of the breast cancer index and comparison to Adjuvant! Online in a clinical case series of early breast cancer.
Prognostic utility of the breast cancer index and comparison to Adjuvant! Online in a clinical case series of early breast cancer.
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DOI：
10.1186/bcr3038
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发表时间：
2011-10-14
期刊：
影响因子：
--
通讯作者：
Brufsky A
中科院分区：
文献类型：
--
作者：
Jankowitz RC;Cooper K;Erlander MG;Ma XJ;Kesty NC;Li H;Chivukula M;Brufsky A
乳腺癌指数 (BCI) 结合了两个独立的生物标志物 HOXB13:IL17BR (H:I) 和 5 基因分子分级指数 (MGI)，分别评估雌激素介导的信号传导和肿瘤分级。 BCI 将早期雌激素受体阳性 (ER+)、淋巴结阴性 (LN-) 乳腺癌患者分为三个风险组，并对个体远处复发风险进行持续评估。当前研究的目的是在临床病例系列中验证 BCI 并比较 BCI 和 Adjuvant!Online (AO) 的预后效用。 265 名接受 ER+LN-他莫昔芬治疗的患者的肿瘤样本是从单一学术机构的癌症研究登记处鉴定出来的。进行 BCI 测定并根据预先确定的风险模型分配分数。通过 BCI 和 AO 评估风险，并将其与患者队列中的临床结果相关联。在 265 名 ER+LN- 患者（中位年龄：56 岁；中位随访时间：10.3 年）中，BCI 是结果的重要预测因子，这些患者单独接受他莫昔芬辅助治疗或他莫昔芬联合化疗 (32%)。 BCI 将 55%、21% 和 24% 的患者分别归类为低风险、中风险和高风险。低、中、高风险组的10年远处复发率分别为6.6%、12.1%和31.9%，乳腺癌特异性死亡率分别为3.8%、3.6%和22.1%。在包括临床病理因素的多变量分析中，BCI 是远处复发（增加 5 个单位的 HR = 5.32 [CI 2.18-13.01；P = 0.0002]）和乳腺癌特异性死亡率（增加 5 个单位的 HR = 9.60 [CI 3.20-28.80；P < 0.0001]）的显着预测因子。 AO 与复发风险显着相关。在一项单独的多变量分析中，BCI 和 AO 均可显着预测结果。在复发风险的时间依赖性 (10 年) ROC 曲线准确性分析中，BCI+AO 的加入将所有患者的预测准确性从 66%（仅 AO）提高到 76%（AO+BCI），而仅接受他莫昔芬治疗的患者则从 65% 提高到 81%。本研究验证了 BCI 在 ER+LN- 患者中的预后表现。在这个典型的低风险队列中，BCI 对高风险组和低风险组进行了分类，10 年远处复发和乳腺癌特异性死亡风险相差约 5 倍。 BCI 和 AO 是独立的预测因子，BCI 具有超出 AO 中包含的护理标准参数的附加效用。
Breast Cancer Index (BCI) combines two independent biomarkers, HOXB13:IL17BR (H:I) and the 5-gene molecular grade index (MGI), that assess estrogen-mediated signalling and tumor grade, respectively. BCI stratifies early-stage estrogen-receptor positive (ER+), lymph-node negative (LN-) breast cancer patients into three risk groups and provides a continuous assessment of individual risk of distant recurrence. Objectives of the current study were to validate BCI in a clinical case series and to compare the prognostic utility of BCI and Adjuvant!Online (AO). Tumor samples from 265 ER+LN- tamoxifen-treated patients were identified from a single academic institution's cancer research registry. The BCI assay was performed and scores were assigned based on a pre-determined risk model. Risk was assessed by BCI and AO and correlated to clinical outcomes in the patient cohort. BCI was a significant predictor of outcome in a cohort of 265 ER+LN- patients (median age: 56-y; median follow-up: 10.3-y), treated with adjuvant tamoxifen alone or tamoxifen with chemotherapy (32%). BCI categorized 55%, 21%, and 24% of patients as low, intermediate and high-risk, respectively. The 10-year rates of distant recurrence were 6.6%, 12.1% and 31.9% and of breast cancer-specific mortality were 3.8%, 3.6% and 22.1% in low, intermediate, and high-risk groups, respectively. In a multivariate analysis including clinicopathological factors, BCI was a significant predictor of distant recurrence (HR for 5-unit increase = 5.32 [CI 2.18-13.01; P = 0.0002]) and breast cancer-specific mortality (HR for a 5-unit increase = 9.60 [CI 3.20-28.80; P < 0.0001]). AO was significantly associated with risk of recurrence. In a separate multivariate analysis, both BCI and AO were significantly predictive of outcome. In a time-dependent (10-y) ROC curve accuracy analysis of recurrence risk, the addition of BCI+AO increased predictive accuracy in all patients from 66% (AO only) to 76% (AO+BCI) and in tamoxifen-only treated patients from 65% to 81%. This study validates the prognostic performance of BCI in ER+LN- patients. In this characteristically low-risk cohort, BCI classified high versus low-risk groups with ~5-fold difference in 10-year risk of distant recurrence and breast cancer-specific death. BCI and AO are independent predictors with BCI having additive utility beyond standard of care parameters that are encompassed in AO.
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