Abstract
Background: The 21-gene recurrence score (RS) assay has been proven prognostic and predictive for hormone receptor-positive/HER2-negative, node-negative early breast cancer patients. However, whether primary 21-gene RS can predict prognosis in recurrent breast cancer patients remained unknown.Patients and Methods: Consecutive breast cancer patients operated in Comprehensive Breast Health Center, Shanghai Ruijin Hospital between January 2009 and December 2018 were retrospectively analyzed. Patients with available 21-gene RS result for the primary tumor and reporting disease recurrence during follow-up were included. Association of 21-gene RS and overall survival (OS), post-recurrence overall survival (PR-OS), post-recurrence progression-free survival (PR-PFS), and first-line systemic treatment after recurrence were compared among different groups.Results: A total of 74 recurrent patients were included, with 10, 27, 37 patients in the RS <18, 18–30, and ≥ 31 groups, respectively. Recurrent patients with RS ≥ 31 were more likely to receive chemotherapy as their first-line treatment compared to those with RS <31 (P = 0.025). Compared to those with RS <31, patients with RS ≥ 31 had significantly worse OS (P = 0.025), worse PR-OS (P = 0.026), and a trend of inferior PR-PFS (P = 0.106). Multivariate analysis demonstrated that primary ER expression level (OS: P = 0.009; PR-OS: P = 0.017) and histological grade (OS: P = 0.003; PR-OS: P = 0.009), but not primary 21-gene RS (OS: P = 0.706; PR-OS: P = 0.120), were independently associated with worse OS and PR-OS.Conclusions: High primary 21-gene RS tended to be associated with worse disease outcome in loco-regional and distant recurrent breast cancer patients, which could influence the first-line systemic treatment after relapse, warranting further clinical evaluation.
Highlights
Breast cancer (BC) is the most common global malignancy in women [1, 2]
Other retrospective studies demonstrated that primary estrogen receptor (ER) status, adjuvant therapy, recurrence free interval, and first recurrence location were independently associated with survival in metastatic BC patients [14,15,16]
2,136 BC patients with 21-gene recurrence score (RS) records were retrospectively reviewed, and their characteristics were listed in Supplementary Table S1
Summary
Breast cancer (BC) is the most common global malignancy in women [1, 2]. Despite standard comprehensive treatment according to clinical and histopathological features, 20–30% early-stage BC will develop loco-regional recurrence (LRR) and/or distant metastasis [3, 4]. Disease outcome of recurrent patients is highly variable and hard to predict, especially in hormone receptor (HR)-positive patients [6]. There are plenty of studies that analyze the predictive and prognostic factors on disease progression in early BC patients [7]. Other retrospective studies demonstrated that primary ER status, adjuvant therapy, recurrence free interval, and first recurrence location were independently associated with survival in metastatic BC patients [14,15,16]. Defining predictive and prognostic factors in the metastatic setting offered great challenges as well as opportunities toward an improved management of BC patients. The 21-gene recurrence score (RS) assay has been proven prognostic and predictive for hormone receptor-positive/HER2-negative, node-negative early breast cancer patients. Whether primary 21-gene RS can predict prognosis in recurrent breast cancer patients remained unknown
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