Abstract
This study aimed to validate the Clinical Treatment Score post-5 years (CTS5)-based risk stratification in a cohort comprising pre- and postmenopausal patients with estrogen receptor (ER)–positive breast cancer. We investigated the clinicopathologic parameters including Ki-67 labelling index (LI) to identify factors affecting late distant recurrence (DR). Women with ER-positive breast cancer who were free of DR for 5 years were identified between January 2004 and December 2009. We investigated the risk of late DR (5–10 years) according to the CTS5 risk group. Cox regression analysis was used to determine the prognostic performance of CTS5 and identify factors associated with late DR. In all, 680 women were included. Of these, 379 (55.7%) were premenopausal and 301 (44.3%) were postmenopausal. At a median follow-up of 118 months, 32 women had late DR. CTS5 was a significant prognostic factor for late DR in both pre- and postmenopausal women. In the low CTS5 group, high Ki-67 LI (> 20%) was a significant risk factor for late DR. CTS5 is a useful tool for assessing the risk of late DR in pre- and postmenopausal women with ER-positive breast cancer. Extended endocrine therapy can be considered in patients with high Ki-67 LI (> 20%) in the low CTS5 group.
Highlights
Over the past few decades, there has been a substantial increase in the incidence of breast cancer w orldwide[1,2,3,4]
Our study revealed that Clinical Treatment Score post-5 years (CTS5) is useful in estimating the risk of late distant recurrence (DR) among pre- and postmenopausal patients with estrogen receptor (ER)-positive breast cancer who are free of DR until 5 years after surgery
The algorithm was developed based on cohorts comprising postmenopausal women at diagnosis, CTS5 predicted the risk of late DR in premenopausal women as well
Summary
Over the past few decades, there has been a substantial increase in the incidence of breast cancer w orldwide[1,2,3,4]. 70–80% of breast cancer patients have an estrogen receptor (ER)-positive subtype, and most are prescribed 5 years of adjuvant endocrine therapy[8,9]. Several randomized clinical trials demonstrated that extended adjuvant endocrine treatment could reduce the risk of late recurrence[12,13,14]. The Clinical Treatment Score post-5 years (CTS5) is a useful tool based on clinical information that can be used to identify patients who could benefit from extended endocrine therapy beyond 5 years[15]. The CTS5, which was developed and validated in two prospective trials, can be clinically used as a supplemental tool to identify the need for extended endocrine therapy in patients who are free of DR after the first 5 years. Clinicians could consider recommending prolonged endocrine therapy for patients with high CTS5 score and discontinue it in those with low CTS5 s core[18]
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