背景:雌激素受体(ER)阳性乳腺癌晚期复发(LR)的机制尚不清楚,正如以前的研究已经分别调查了“基因表达谱”和“临床病理因素”。\"因此,本研究旨在通过结合基因表达谱(42基因分类器:42GC)和临床病理因素(5年后临床治疗评分:CTS5)这两个独立因素,在多个大型队列中评估LR的预测能力.
方法:我们分析了从28个全球队列的公共数据库下载的微阵列CEL文件数据。总共2454例ER阳性乳腺癌患者进行了42GC分析,其中1263个,对具有完整临床病理数据的CTS5进行分析。
结果:在对复发患者的分析中,42GCLR和CTS5低危组倾向于有LR。值得注意的是,在对有复发和无复发患者的分析中,在CTS5高危组中,5年以上的LR率最高.42GC和CTS5高危人群的组合显示出最高的LR率(16.9%),显著超过42GC非LR(NLR)和CTS5低风险组合(5.41%)(p=0.038,比值比=3.53)。此外,结合第三个因素,95GC,可能减少了大约四分之一的患者优先接受延长激素治疗的患者数量.
结论:结果证实了这两个因素,基因表达谱和临床病理因素,影响复发时间。它还表明,LR的生物学易感性(CTS5低风险)与高LR率(CTS5高风险)不同。在临床实践中,42GCLR和CTS5高危组合的患者应优先接受延长激素治疗.将CTS5和95GC添加到42GC可以更好地对LR进行风险分类。
BACKGROUND: The mechanism of late recurrence (LR) of estrogen receptor (ER)-positive breast cancer remains unclear, as previous studies have separately investigated \"gene expression profiles\" and \"clinicopathological factors.\" Thus, this study aimed to evaluate the predictive capability of LR by combining the two independent factors of gene expression profiles (42-gene classifier: 42GC) and clinicopathological factors (Clinical Treatment Score post-5 years: CTS5) in multiple large cohorts.
METHODS: We analyzed microarray CEL file data downloaded from public databases of 28 global cohorts. A total of 2,454 patients with ER-positive breast cancer were analyzed for 42GC, and 1,263 of these, with complete clinicopathological data were analyzed for CTS5.
RESULTS: In the analysis of recurrent patients, the 42GC LR and CTS5 low-risk group tended to have LR. Notably, in the analysis of patients with and without recurrence, the highest LR rate beyond 5 years was observed in the CTS5 high-risk group. The combination of the 42GC and CTS5 high-risk groups showed the highest LR rate (16.9%), significantly exceeding that of the 42GC non-LR (NLR) and CTS5 low-risk combination (5.41%) (p = 0.038, odds ratio = 3.53). Furthermore, incorporating a third factor, 95GC, potentially reduced the number of patients prioritized for extended hormonal therapy for approximately one-quarter of patients.
CONCLUSIONS: Results confirmed that the two factors, gene expression profiles and clinicopathological factors, affect the time of recurrence. It also showed that the biological predisposition for LR (CTS5 low-risk) differed from the high LR rate (CTS5 high-risk). In clinical practice, patients with the 42GC LR and CTS5 high-risk combination should be prioritized for extended hormonal therapy. The addition of CTS5 and 95GC to 42GC allows for better risk classification of LR.