Community clinical practice patterns and mortality in patients with intermediate oncotype DX recurrence scores: Who benefits from chemotherapy?
Community clinical practice patterns and mortality in patients with intermediate oncotype DX recurrence scores: Who benefits from chemotherapy?
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作者：
Ibraheem AF;Press DJ;Olopade OI;Huo D
Oncotype DX复发评分（RS）被用作决定激素受体阳性、HER 2阴性乳腺癌化疗的工具。在淋巴结阴性、RS 11-25、年龄≥50的患者中，化疗没有获益，但在淋巴结阳性组中，化疗的获益仍未知。基于2010年至2014年的国家癌症数据库，一项全国性回顾性队列研究纳入了73，185例1-3A期和RS 11-30的女性乳腺癌患者。在多变量考克斯模型中，在校正其他预后因素后，接受化疗与淋巴结阳性乳腺癌患者的死亡风险降低相关（风险比[HR] 0.58，95% CI 0.45-0.74; p<0.001）。RS 11-17、18-25和26-30亚组的5年生存率增益范围分别为1.3%、3.3%至6.7%。在淋巴结阴性患者中，化疗与RS 25-30患者的死亡风险降低相关（HR 0.68，95% CI 0.48-0.96; p=0.03; 5年生存率增加1.8%），但对于RS 11-17的患者，化疗无获益（HR 0.97，95% CI 0.61-1.55; p=0.90），RS 18-25的女性获益轻微（HR 0.79，95% CI 0.62-1.00; p=0.05）。使用倾向评分匹配方法观察到类似的结果。中度RS乳腺癌患者的化疗获益由RS以非线性方式驱动：RS越高，绝对获益越大。这项研究的结果强调了真实的世界数据在实践中为联合决策提供信息的实用性。使用美国国家癌症数据库中73,185例女性乳腺癌患者的真实的世界数据，我们发现化疗对淋巴结阳性疾病和复发评分11-30的患者以及淋巴结阴性疾病和复发评分26-30的患者具有统计学显著的保护作用。在淋巴结阴性疾病和复发评分11-25的患者中，我们发现使用化疗没有益处，这与新报道的TAILORx研究一致。
Oncotype DX recurrence score (RS) is used as a tool for making decision about chemotherapy in hormone receptor-positive, HER2-negative breast cancer. There is no benefit of chemotherapy in node negative, RS 11–25, age ≥50 patients but the benefit of chemotherapy in the node positive group remains unknown. Based on National Cancer Database between 2010 and 2014, a nationwide retrospective cohort study included 73,185 female breast cancer patients with stage 1–3A and RS 11–30. Receipt of chemotherapy was associated with a reduced risk of death among patients with node positive breast cancer (hazard ratio [HR] 0.58, 95% CI 0.45–0.74; p<0.001), after adjusting for other prognostic factors in multivariable Cox model. The 5-year survival gain ranges from 1.3%, 3.3% to 6.7% for the RS 11–17, 18–25, and 26–30 subgroups respectively. Among patients with node negative disease, chemotherapy was associated with a reduced risk of death for patients with RS 25–30 (HR 0.68, 95% CI 0.48–0.96; p=0.03; 5-year survival gain 1.8%), but there was no benefit of chemotherapy for patients with RS 11–17 (HR 0.97, 95% CI 0.61–1.55; p=0.90) and marginally significant benefit for women with RS 18–25 (HR 0.79, 95% CI 0.62–1.00; p=0.05). Similar results were observed using propensity score matching method. The benefit of chemotherapy for breast cancer patients with intermediate RS is driven in a non-linear fashion by RS: the higher the RS, the larger the absolute benefit. Findings from this study underscore the utility of real world data to inform joint decision making in practice. Using real world data from 73,185 female patients with breast cancer in the US National Cancer Database, we found a statistically significant protective effect of chemotherapy for patients with node positive disease and recurrence score 11–30, and patients with node negative disease and recurrence score 26–30. In patients with node negative disease and recurrence score 11–25, we found no benefit with the use of chemotherapy, which is consistent with the newly reported TAILORx study.
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DOI：
10.1056/nejmoa1510764
发表时间：
2015-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sparano JA;Gray RJ;Makower DF;Pritchard KI;Albain KS;Hayes DF;Geyer CE Jr;Dees EC;Perez EA;Olson JA Jr;Zujewski J;Lively T;Badve SS;Saphner TJ;Wagner LI;Whelan TJ;Ellis MJ;Paik S;Wood WC;Ravdin P;Keane MM;Gomez Moreno HL;Reddy PS;Goggins TF;Mayer IA;Brufsky AM;Toppmeyer DL;Kaklamani VG;Atkins JN;Berenberg JL;Sledge GW
通讯作者：
Sledge GW
影响因子：
2.2
作者：
Ramsey, Scott D.;Barlow, William E.;Hortobagyi, Gabriel N.
通讯作者：
Hortobagyi, Gabriel N.
DOI：
10.1056/nejmoa1804710
发表时间：
2018-07-12
期刊：
The New England journal of medicine
影响因子：
--
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
在美国临床实践中，对乳腺癌的21基因复发评分测定法的利用和影响：从2010年到2012年的国家癌症数据库分析中学到的经验教训。
影响因子：
3.8
作者：
Orucevic A;Heidel RE;Bell JL
通讯作者：
Bell JL
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY