Abstract
BackgroundThe 21-gene recurrence score (RS) can predict chemotherapy benefit in estrogen receptor-positive, human epidermal growth factor receptor-2-negative (ER+/HER2-) early breast cancer patients. Age would influence the interaction between RS and chemotherapy effect. The current study aimed to determine RS thresholds which were predictive of chemotherapy benefit in young and old women, respectively.MethodsPatients diagnosed with pN0–1, ER+/HER2- breast cancer between 2009 and 2016 were retrospectively reviewed. Propensity score matching was performed according to chemotherapy usage. After stratifying patients with different cutoffs of age, the RS threshold indicating chemotherapy benefit in each age strata were determined by cox proportional hazard models.ResultsA total of 1227 patients were included. The median age was 58 years and the median RS was 24. After matching, the RS thresholds suggesting chemotherapy benefit varied with age. For patients ≤55 years, chemotherapy benefit was observed in those having RS > 25 (P = 0.03), with 4-year invasive disease-free survival (IDFS) of 97.0 and 89.3% in patients receiving chemotherapy or not. While patients derived no benefit from chemotherapy if they had RS ≤25 (P = 0.66, 4-year IDFS: 95.3% vs. 94.6%). For patients > 55 years, adjuvant chemotherapy was associated with better prognosis in those with RS > 36 (P = 0.014, 4-year IDFS: 94.7% vs. 76.2%), but not in those having RS ≤36 (P = 0.13, 4-year IDFS: 92.3% vs. 95.8%).ConclusionsOld patients need higher RS thresholds to demonstrate the chemotherapy benefit. Further efforts are warranted to investigate the association between age and predictive RS thresholds.
Highlights
The 21-gene recurrence score (RS) can predict chemotherapy benefit in estrogen receptor-positive, human epidermal growth factor receptor-2-negative (ER+/Human epidermal growth factor receptor-2negative (HER2)-) early breast cancer patients
For patients older than 55 years, adjuvant chemotherapy was associated with better prognosis in those who had RS > 36 (P = 0.014; Fig. 4D), with 4-year invasive disease-free survival (IDFS) of 94.7 and 76.2% respectively
In the current study, we demonstrated the distribution of RS in a cohort of 1227 Chinese breast cancer patients and validated the prognostic value of RS
Summary
The 21-gene recurrence score (RS) can predict chemotherapy benefit in estrogen receptor-positive, human epidermal growth factor receptor-2-negative (ER+/HER2-) early breast cancer patients. Multigene assays for specific molecular subtype trace the intrinsic characteristics of tumors and contribute to risk assessment [1] Among those assays, the 21-gene recurrence score (RS) testing is well-acknowledged and increasingly used for estrogen receptor-positive, human epidermal growth factor receptor-2-negative (ER+/HER2-) breast cancer patients [2]. The 21-gene RS is measured by the quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) method, and classified as low-risk (< 18), intermediaterisk (18–30), and high-risk (> 30) It could quantify the risk of distant relapse as well as predict chemotherapy benefit in ER+/HER2-, lymph node (LN)-negative patients [3, 4]. The TAILORx and WSG Plan-B prospective trial used different cutoff values for risk stratification and consolidated the role of this genomic tool in guiding chemotherapy usage [6, 7]
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