背景:乳腺癌,尽管是美国女性第二常见的恶性肿瘤,在40岁以下的患者中很少见。然而,这个年轻的患者群体有很高的复发率和死亡率,化疗经常用作辅助治疗。我们旨在确定年龄是否是化疗推荐和后续治疗的独立预测因素,以及与Dx型(ODX)复发评分(RS)的关系。
方法:从2010-2016年对国家癌症数据库进行了回顾性审查,以确定早期女性(pT1-pT3,pN0-pN1mic,M0),激素受体阳性,接受ODXRS检测的人表皮生长因子受体2阴性乳腺癌。
结果:在95,382名符合纳入标准的患者中,使用传统ODXRS截止值的风险组低59%,33%中间体,高8%。使用试验分配治疗RS截止值的个性化选项,风险组低23%,62%中间体,15%高。化疗建议随着诊断年龄的增加而减少(P<0.001)。在单变量模型中,年龄的增加与化疗推荐几率的降低相关,两者都是连续的(比值比:0.98,95%置信区间0.97-0.98;P<0.001)和分类的十年(P<0.001)。10岁仍然是化疗推荐的独立预测因素(P<0.001)。针对风险群体进行调整。
结论:在接受ODX检测的早期激素受体阳性乳腺癌患者中,化疗推荐和治疗因年龄而异。虽然分子谱分析已被证明可以准确预测化疗的益处,诊断年龄较小是乳腺癌治疗策略不一致使用ODXRS的危险因素;年龄在18-39岁的患者受影响较大.
BACKGROUND: Breast cancer, although the second most common malignancy in women in the United States, is rare in patients under the age of 40 y. However, this young patient population has high recurrence and mortality rates, with chemotherapy frequently used as adjuvant treatment. We aimed to determine whether age is an independent predictor of chemotherapy recommendation and subsequent treatment and the relationship to Oncotype Dx (ODX) recurrence score (RS).
METHODS: The National Cancer Database was retrospectively reviewed from 2010-2016 to identify women with early-stage (pT1-pT3, pN0-pN1mic, M0), hormone receptor positive, human epidermal growth factor receptor 2 negative breast cancer who underwent ODX RS testing.
RESULTS: Of 95,382 patients who met the inclusion criteria, risk groups using the traditional ODX RS cutoffs were 59% low, 33% intermediate, and 8% high. Using Trial Assigning Individualized Options for Treatment RS cutoffs, risk groups were 23% low, 62% intermediate, and 15% high. Chemotherapy recommendation decreased as age at diagnosis increased (P < 0.001). Increasing age was associated with decreased odds of chemotherapy recommendation in univariate models both continuously (odds ratio: 0.98, 95% confidence interval 0.97-0.98; P < 0.001) and categorically by decade (P < 0.001). Age by decade remained an independent prognosticator of chemotherapy recommendation (P < 0.001), adjusted for risk groups.
CONCLUSIONS: Chemotherapy recommendation and treatment differs by age among patients with early-stage hormone receptor positive breast cancer who undergo ODX testing. While molecular profiling has been shown to accurately predict the benefit of chemotherapy, younger age at diagnosis is a risk factor for discordant use of ODX RS for treatment strategies in breast cancer; with patients aged 18-39 disproportionately affected.