Validation of the RSClin risk calculator in the National Cancer Data Base.
Validation of the RSClin risk calculator in the National Cancer Data Base.
复制标题
在国家癌症数据库中验证 RSClin 风险计算器。
DOI：
10.1002/cncr.35163
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发表时间：
2024
期刊：
影响因子：
6.2
通讯作者：
Howard,FrederickM
中科院分区：
文献类型：
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作者：
Vannier,AugustinGL;Dhungana,Asim;Zhao,Fangyuan;Chen,Nan;Shubeck,Sarah;Hahn,OlwenM;Nanda,Rita;Jaskowiak,NoraT;Fleming,GiniF;Olopade,OlufunmilayoI;Pearson,AlexanderT;Huo,Dezheng;Howard,FrederickM
背景：指南推荐使用基因组测定，如OncotypeDx，以帮助决定激素受体阳性，HER2阴性（HR+/HER2−）乳腺癌是否使用化疗。RSClin预后工具整合了OncotypeDx和临床病理特征来预测远处复发和化疗效果，但在广泛临床应用之前需要进一步验证。方法本研究纳入了2010年至2020年在美国国家癌症数据库（NCDB）中诊断为I-III期HR+/HER2 -乳腺癌的患者，这些患者接受了辅助内分泌治疗或不接受化疗。RSClin‐预测的化疗获益分为低（远端复发减少<3%）、中（3% - 5%）和高（5% - 5%）。Cox模型用于模拟年龄、合并症指数、保险和种族/民族调整后的死亡率。结果共有285,441例患者被纳入NCDB，平均年龄为60岁，中位随访时间为58个月。化疗与总生存期改善相关的仅是那些预计具有中等（校正风险比[aHR]， 0.68； 95%可信区间[CI]， 0.60-0.79）和高收益的RSClin患者（aHR, 0.66; 95% CI, 0.61-0.72）。在低OncotypeDx评分（<26）和中等（aHR, 0.66; 95% CI, 0.53-0.82）或高（aHR, 0.71; 95% CI, 0.58-0.86） RSClin预测获益的亚组中可以看到一致的获益。高OncotypeDx评分（≥26）和低RSClin获益的患者化疗无生存获益（aHR, 1.70; 95% CI, 0.41-6.99）。结论srsclin可能比OncotypeDx更准确地识别从强化治疗中获益的高危患者，需要进一步的前瞻性研究。
BackgroundGuidelines recommend the use of genomic assays such as OncotypeDx to aid in decisions regarding the use of chemotherapy for hormone receptor–positive, HER2‐negative (HR+/HER2−) breast cancer. The RSClin prognostic tool integrates OncotypeDx and clinicopathologic features to predict distant recurrence and chemotherapy benefit, but further validation is needed before broad clinical adoption.MethodsThis study included patients from the National Cancer Data Base (NCDB) who were diagnosed with stage I–III HR+/HER2− breast cancer from 2010 to 2020 and received adjuvant endocrine therapy with or without chemotherapy. RSClin‐predicted chemotherapy benefit was stratified into low (<3% reduction in distant recurrence), intermediate (3%–5%), and high (>5%). Cox models were used to model mortality adjusted for age, comorbidity index, insurance, and race/ethnicity.ResultsA total of 285,441 patients were identified for inclusion from the NCDB, with an average age of 60 years and a median follow‐up of 58 months. Chemotherapy was associated with improved overall survival only for those predicted to have intermediate (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.60–0.79) and high benefit per RSClin (aHR, 0.66; 95% CI, 0.61–0.72). Consistent benefit was seen in the subset with a low OncotypeDx score (<26) and intermediate (aHR, 0.66; 95% CI, 0.53–0.82) or high (aHR, 0.71; 95% CI, 0.58–0.86) RSClin‐predicted benefit. No survival benefit with chemotherapy was seen in patients with a high OncotypeDx score (≥26) and low benefit per RSClin (aHR, 1.70; 95% CI, 0.41–6.99).ConclusionsRSClin may identify high‐risk patients who benefit from treatment intensification more accurately than OncotypeDx, and further prospective study is needed.