PDF(Pubmed)
Abstract：
BACKGROUND: There is currently no standardised definition for patients at high risk of recurrence of human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (eBC; stages 1-3) after surgery. This modified Delphi panel aimed to establish expert UK consensus on this definition, separately considering hormone receptor (HR)-positive and triple-negative (TN) patients.
METHODS: Over three consecutive rounds, results were collected from 29, 24 and 22 UK senior breast cancer oncologists and surgeons, respectively. The first round aimed to determine key risk factors in each patient subgroup; subsequent rounds aimed to establish appropriate risk thresholds. Consensus was pre-defined as ≥70% of respondents.
RESULTS: Expert consensus was achieved on need to assess age, tumour size, tumour grade, number of positive lymph nodes, inflammatory breast cancer and risk prediction tools in all HER2-negative patients. There was additional agreement on use of tumour profiling tests and biomarkers in HR-positive patients, and pathologic complete response (pCR) status in TN patients. Thresholds for high recurrence risk were subsequently agreed. In HR-positive patients, these included age <35 years, tumour size >5 cm (as independent risk factors); tumour grade 3 (independently and combined with other high-risk factors); number of positive nodes ≥4 (independently) and ≥1 (combined). For TN patients, the following thresholds reached consensus, both independently and in combination with other factors: tumour size >2 cm, tumour grade 3, number of positive nodes ≥1.
CONCLUSIONS: The results may be a valuable reference point to guide recurrence risk assessment and decision-making after surgery in the HER2-negative eBC population.
METHODS: Over three consecutive rounds, results were collected from 29, 24 and 22 UK senior breast cancer oncologists and surgeons, respectively. The first round aimed to determine key risk factors in each patient subgroup; subsequent rounds aimed to establish appropriate risk thresholds. Consensus was pre-defined as ≥70% of respondents.
RESULTS: Expert consensus was achieved on need to assess age, tumour size, tumour grade, number of positive lymph nodes, inflammatory breast cancer and risk prediction tools in all HER2-negative patients. There was additional agreement on use of tumour profiling tests and biomarkers in HR-positive patients, and pathologic complete response (pCR) status in TN patients. Thresholds for high recurrence risk were subsequently agreed. In HR-positive patients, these included age <35 years, tumour size >5 cm (as independent risk factors); tumour grade 3 (independently and combined with other high-risk factors); number of positive nodes ≥4 (independently) and ≥1 (combined). For TN patients, the following thresholds reached consensus, both independently and in combination with other factors: tumour size >2 cm, tumour grade 3, number of positive nodes ≥1.
CONCLUSIONS: The results may be a valuable reference point to guide recurrence risk assessment and decision-making after surgery in the HER2-negative eBC population.
摘要：
背景：目前对于手术后人类表皮生长因子受体2（HER2）阴性早期乳腺癌（eBC；1-3期）复发风险高的患者尚无标准化定义。这个修改后的德尔福小组旨在就这一定义建立英国专家共识，分别考虑激素受体（HR）阳性和三阴性（TN）患者。
方法：连续三轮，结果来自29、24和22名英国资深乳腺癌肿瘤学家和外科医生，分别。第一轮旨在确定每个患者亚组的关键风险因素；随后的几轮旨在建立适当的风险阈值。共识被预先定义为≥70%的受访者。
结果：在需要评估年龄方面达成了专家共识，肿瘤大小，肿瘤分级,阳性淋巴结数,所有HER2阴性患者的炎性乳腺癌和风险预测工具。在HR阳性患者中使用肿瘤谱分析测试和生物标志物方面达成了更多共识，TN患者的病理完全缓解（pCR）状态。随后达成了高复发风险阈值。在HR阳性患者中，这些包括年龄<35岁，肿瘤大小>5cm（作为独立危险因素）；肿瘤3级（独立且与其他高危因素合并）；阳性淋巴结数≥4（独立）和≥1（合并）。对于TN患者，以下门槛达成共识，独立和与其他因素结合：肿瘤大小>2厘米，肿瘤3级，阳性结节数≥1。
结论：该结果可能是指导HER2阴性eBC人群术后复发风险评估和决策的有价值的参考点。
方法：连续三轮，结果来自29、24和22名英国资深乳腺癌肿瘤学家和外科医生，分别。第一轮旨在确定每个患者亚组的关键风险因素；随后的几轮旨在建立适当的风险阈值。共识被预先定义为≥70%的受访者。
结果：在需要评估年龄方面达成了专家共识，肿瘤大小，肿瘤分级,阳性淋巴结数,所有HER2阴性患者的炎性乳腺癌和风险预测工具。在HR阳性患者中使用肿瘤谱分析测试和生物标志物方面达成了更多共识，TN患者的病理完全缓解（pCR）状态。随后达成了高复发风险阈值。在HR阳性患者中，这些包括年龄<35岁，肿瘤大小>5cm（作为独立危险因素）；肿瘤3级（独立且与其他高危因素合并）；阳性淋巴结数≥4（独立）和≥1（合并）。对于TN患者，以下门槛达成共识，独立和与其他因素结合：肿瘤大小>2厘米，肿瘤3级，阳性结节数≥1。
结论：该结果可能是指导HER2阴性eBC人群术后复发风险评估和决策的有价值的参考点。
