Changes in Recurrence Score by neoadjuvant endocrine therapy of breast cancer and their prognostic implication
Changes in Recurrence Score by neoadjuvant endocrine therapy of breast cancer and their prognostic implication
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DOI：
10.1136/esmoopen-2018-000476
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发表时间：
2019-01-01
期刊：
影响因子：
7.3
通讯作者：
Toi, Masakazu
中科院分区：
文献类型：
--
作者：
Ueno, Takayuki;Saji, Shigehira;Toi, Masakazu
背景新辅助内分泌治疗（NET）可以改善绝经后激素受体阳性乳腺癌患者的手术结局。NET后Ki 67标记指数较基线时具有更好的预后能力。然而，它仍然是未知的，是否与治疗后的样品多基因检测可以预测预后比pretreatmentsamples.Methods的预后价值的多基因检测肿瘤型DX复发评分（RS）进行了研究，使用治疗前和治疗后的样品从多中心NET试验，JFMC 34 -0601结果治疗前和治疗后的RS均与无病生存率（DFS）显著相关（分别为p=0.005和0.002）。治疗前和治疗后RS的组合也是DFS的预测因子（p=0.002），并且上级于术前内分泌预后指数（PEPI）。此外，在三种RS中，组合RS是多变量分析中唯一的独立预后因素（p=0.04）。此外，联合RS可以区分高危组的早期复发和中危组的中/晚期复发，结论治疗前后RS的联合检测可为预测DFS和区分高危组和中危组的早期复发提供关键信息。中危组激素受体阳性乳腺癌患者的晚期复发。需要进行更大规模的研究来验证结果。
Background Neoadjuvant endocrine therapy (NET) can improve surgical outcomes in postmenopausal patients with hormone receptor-positive breast cancer. The Ki67 labelling index after NET has a better prognostic power than that at baseline. However, it remains unknown whether a multigene assay with post-treatment samples could predict the prognosis better than that with pretreatment samples.Methods The prognostic value of the multigene assay Oncotype DX Recurrence Score (RS) was investigated using pretreatment and post-treatment samples from a multicentre NET trial, JFMC34-0601 (UMIN C000000345), where exemestane was given at 25 mg/day for 24 weeks.Results Both pretreatment and post-treatment RSs were significantly associated with disease-free survival (DFS) (p=0.005 and 0.002, respectively). The combination of pretreatment and post-treatment RSs was also a predictor of DFS (p=0.002) and superior to preoperative endocrine prognostic index (PEPI). Furthermore, combined RS was the only independent prognostic factor in the multivariate analysis among the three RSs (p=0.04). In addition, combined RS could differentiate early recurrence in the high-risk group from mid/late recurrence in the intermediate-risk group, suggesting possible differential treatment strategies based on the risk categories indicated by the combined RS.Conclusions The combination of pretreatment and post-treatment RSs could provide pivotal information for predicting DFS and differentiating early recurrence in the high-risk group from mid/late recurrence in the intermediate-risk group in patients with hormone receptor-positive breast cancer. A larger study is required to validate the results.