Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics.
Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics.
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DOI：
10.1093/jnci/djn309
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发表时间：
2008-10-01
期刊：
影响因子：
--
通讯作者：
Dowsett M
中科院分区：
文献类型：
--
作者：
Ellis MJ;Tao Y;Luo J;A'Hern R;Evans DB;Bhatnagar AS;Chaudri Ross HA;von Kameke A;Miller WR;Smith I;Eiermann W;Dowsett M
了解肿瘤反应如何与复发风险相关，将有助于临床医生为接受雌激素受体阳性（ER+）乳腺癌新辅助内分泌治疗的患者做出额外治疗选择的决定。在P024新辅助内分泌治疗试验中，对228例确诊为ER+2期和3期乳腺癌的绝经后妇女的肿瘤进行了治疗后ER状态、Ki67增殖指数、组织学分级、病理肿瘤大小、淋巴结状态和治疗反应的分析，该试验比较了术前4个月来曲唑和他莫昔芬的治疗效果。考克斯比例风险被用来确定158名妇女的无复发生存期（RFS）和乳腺癌特异性生存期（BCSS）的相关因素。RFS的术前内分泌预后指数（PEPI）是根据这些数据制定的，并在IMPACT试验的203名绝经后妇女的独立研究中得到验证，该研究比较了术前3个月阿那曲唑、他莫昔芬或联合用药的治疗。统计检验是双侧的。P024的中位随访时间为61.2个月。经证实的基线ER+临床2期和3期肿瘤患者在手术时降级为1期或0期，RFS为100%（与更高分期相比，P <0.001）。治疗后肿瘤特征的多变量检验显示，病理肿瘤大小、淋巴结状态、Ki67水平和ER状态与RFS和BCSS独立相关。基于这些因素的PEPI模型预测了IMPACT试验中的RFS（P = .002）。新辅助内分泌治疗后病理学分期为1期或0期且手术标本中的低风险生物标志物特征（PEPI评分0）的乳腺癌患者复发风险极低，因此不太可能从辅助化疗中获益。
Understanding how tumor response is related to relapse risk would help clinicians make decisions about additional treatment options for patients who have received neoadjuvant endocrine treatment for estrogen receptor–positive (ER+) breast cancer. Tumors from 228 postmenopausal women with confirmed ER+ stage 2 and 3 breast cancers in the P024 neoadjuvant endocrine therapy trial, which compared letrozole and tamoxifen for 4 months before surgery, were analyzed for posttreatment ER status, Ki67 proliferation index, histological grade, pathological tumor size, node status, and treatment response. Cox proportional hazards were used to identify factors associated with relapse-free survival (RFS) and breast cancer–specific survival (BCSS) in 158 women. A preoperative endocrine prognostic index (PEPI) for RFS was developed from these data and validated in an independent study of 203 postmenopausal women in the IMPACT trial, which compared treatment with anastrozole, tamoxifen, or the combination 3 months before surgery. Statistical tests were two-sided. Median follow-up in P024 was 61.2 months. Patients with confirmed baseline ER+ clinical stage 2 and 3 tumors that were downstaged to stage 1 or 0 at surgery had 100% RFS (compared with higher stages, P < .001). Multivariable testing of posttreatment tumor characteristics revealed that pathological tumor size, node status, Ki67 level, and ER status were independently associated with both RFS and BCSS. The PEPI model based on these factors predicted RFS in the IMPACT trial (P = .002). Breast cancer patients with pathological stage 1 or 0 disease after neoadjuvant endocrine therapy and a low-risk biomarker profile in the surgical specimen (PEPI score 0) have an extremely low risk of relapse and are therefore unlikely to benefit from adjuvant chemotherapy.
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影响因子：
45.3
作者：
Smith, IE;Dowsett, M;Walsh, G
通讯作者：
Walsh, G
影响因子：
45.3
作者：
Mazouni, Chafika;Peintinger, Florentia;Pusztai, Lajos
通讯作者：
Pusztai, Lajos
影响因子：
4.4
作者：
Hu, Zhiyuan;Fan, Cheng;Perou, Charles M.
通讯作者：
Perou, Charles M.
影响因子：
37.8
作者：
Morrow, DA;Antman, EM;Braunwald, E
通讯作者：
Braunwald, E
影响因子：
45.3
作者：
Dowsett, M;Ebbs, SR;Smith, IE
通讯作者：
Smith, IE