背景:基于21基因基因组分析的复发评分(RS)经常用于评估乳腺癌中选择辅助化疗的远处复发风险。目前尚不清楚RS是否是TAILORx试验人群中乳腺癌特异性生存率(BCSS)和总生存率(OS)的独立预后因素。
方法:我们使用多变量Cox比例风险回归分析评估了RS与BCSS和OS加上无复发间隔(RFI)和无侵袭性疾病生存期(DFS)的相关性,调整临床病理测量,在8,916名激素受体阳性患者中,HER2阴性,淋巴结阴性乳腺癌。似然比(LR)检验用于评估RS对BCSS提供的预后信息的相对量,操作系统,RFI,和DFS,相对而言。
结果:BCSS的事件率,操作系统,RFI,DFS为1.7%,5.2%,5.6%,12.6%,分别,长达11.6年的随访。与低范围RS(0-10)相比,中度(11-25)和高范围(26-100)RS患者的BCSS较差(调整后的风险比[aHR],5.12[95%CI,2.09-16.92]和8.03[95%CI,2.91-28.47],分别)和RFI(AHR,1.68[95%CI,1.23-2.36]和3.05[95%CI,2.02-4.67],分别),独立于临床病理因素。高范围评分与DFS风险增加相关(aHR,1.56[95%CI,1.20-2.04]),但与OS(AHR,1.44[95%CI,0.95-2.18])。中端评分与DFS(AHR,1.15[95%CI,0.96-1.38])和OS(HR1.14[95%CI,0.87-1.52])。RFI和BCSS的LR-χ2值分别为83.0和65.1,分别,操作系统和DFS的17.5和33.6,分别(P<0.0001)。
结论:RS是早期乳腺癌患者BCSS和复发预后的独立指标。它携带更多关于乳腺癌特异性结果的预后信息。
BACKGROUND: Recurrence score (RS) based on a 21-gene genomic assay is frequently used to estimate risk of distant recurrence for choice of adjuvant chemotherapy in breast cancer. It remains unclear whether RS is an independent prognostic factor for breast cancer-specific survival (BCSS) and overall survival (OS) in the TAILORx trial population.
METHODS: We evaluated the association of RS with BCSS and OS plus recurrence-free interval (RFI) and invasive disease-free survival (DFS) using multivariable Cox proportional hazards regression analysis, adjusting for clinicopathologic measures, in 8,916 patients with hormone receptor-positive, HER2-negative, node-negative breast cancer. Likelihood ratio (LR) test was used to assess the relative amount of prognostic information provided by RS to BCSS, OS, RFI, and DFS, comparatively.
RESULTS: Event rates for BCSS, OS, RFI, and DFS were 1.7%, 5.2%, 5.6%, and 12.6%, respectively, by up to 11.6 years of follow-up. Compared with low-range RS (0-10), patients with midrange (11-25) and high-range (26-100) RS had inferior BCSS (adjusted hazard ratio [aHR], 5.12 [95% CI, 2.09-16.92] and 8.03 [95% CI, 2.91-28.47], respectively) and RFI (aHR, 1.68 [95% CI, 1.23-2.36] and 3.05 [95% CI, 2.02-4.67], respectively), independent of clinicopathologic factors. High-range score was associated with an increased risk of DFS (aHR, 1.56 [95% CI, 1.20-2.04]) but not significantly associated with OS (aHR, 1.44 [95% CI, 0.95-2.18]). Midrange score was associated with neither DFS (aHR, 1.15 [95% CI, 0.96-1.38]) nor OS (HR 1.14 [95% CI, 0.87-1.52]). LR-χ2 values were 83.0 and 65.1 for RFI and BCSS, respectively, and 17.5 and 33.6 for OS and DFS, respectively (P<.0001).
CONCLUSIONS: RS is an independent measure for BCSS and recurrence prognoses relative to OS in early-stage breast cancer. It carries more prognostic information for breast cancer-specific outcomes.