Validation of CTS5 model in large-scale breast cancer population and the impact of menopausal and HER2 status on its prognostic value

Changjun Wang,Yan Lin,Qiang Sun,Xin Huang,Xuefei Wang,Yidong Zhou,Hanjiang Zhu,Feng Mao,Jing Yang,Xiaohui Zhang,Songjie Shen,Bin Zhao,Chang Chen

doi:10.1038/s41598-020-61648-1

Abstract

Clinical Treatment Score post-5 years (CTS5) is a promising prognostic tool to evaluate late recurrence risk for breast cancer. Our study aimed to validate its prognostic value in large-scale population and explore the impact of menopausal and HER2 status on CTS5 model. We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Survival analyses were conducted to assess the prognostic value of CTS5 in different breast cancer subgroups in terms of overall survival (OS) and breast cancer specific survival (BCSS) after five years. A total of 23,168 breast cancer patients with positive hormone receptor (HoR) were enrolled. Postmenopausal and premenopausal patients were 13,686 and 9,482, respectively. Taking CTS5 score as a continuous variable, it had significant positive correlation with poor prognosis beyond five years in both postmenopausal and premenopausal subgroups. Nevertheless, for HER2+ postmenopausal patients, the model has less effective prognostic value on long-term BCSS [HR1.177 (95%CI 0.960–1.443), p = 0.117]. Using CTS5 score as a categorical variable, HER2- patients with high-risk level revealed significant poor survival in terms of both BCSS and OS, irrespective of menopausal status. Our study showed the CTS5 model could be a useful prognostic tool for predict long-term survival in HoR+/HER2- patients. And further large-scale studies are warranted to assess its prognostic value for HER2+ patients and develop novel prediction model for late recurrence risk estimation.

Highlights

Breast cancer had the highest incidence among all the female malignancies worldwide[1,2]
Deaths due to non-breast causes were more common in postmenopausal patients (Post- vs. Pre-: 1.0% vs. 0.1%; p < 0.001), and the proportion of deaths due to breast cancer was comparable in two groups (Post- vs. Pre-: 0.5% vs. 0.7%; p = 0.094)
Prolonging endocrine therapy may reduce the occurrence of recurrence and metastases beyond five years for hormone receptor (HoR)+ patients, but potentially increased risk of endometrial complications, thromboembolic events, fractures, cardiovascular disease and other adverse effects[12,13,14,15]

Summary

Introduction

Breast cancer had the highest incidence among all the female malignancies worldwide[1,2]. Patients with HoR+ tumors currently received five years adjuvant endocrine therapy as standard treatment. The existing data on personalized strategy for HoR+ patients to extend endocrine therapy beyond five years were still contradictory, and the optimal duration and protocol remained unclear. Study by Dowsett et al.[9] developed a concise prognostic tool to estimate risk of late distant recurrence (Clinical Treatment Score post-5 years [CTS5]) on the basis of clinicopathologic parameters. The CTS5 model was developed based on retrospective data, its calibration and discrimination needed further external evaluation in large-scale breast cancer datasets. The present study intended to use large-scale data from SEER database to assess the power of CTS5 as a prediction model and the impact of menopausal and HER2 status on its performance

Methods

Results

Conclusion