Abstract
BackgroundThe prognostic or predictive value of commonly used multigene assays in young patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer is unclear. In this study, we assessed the prognostic value of the GenesWell BCT assay according to age group.MethodsWe identified patients with pN0-1, HR+/HER2− breast cancer in a prospective cohort of women who underwent surgery between 2005 and 2017. The GenesWell BCT assay was performed on tissue samples from selected patients. Distant metastasis-free survival (DMFS) and disease-free survival (DFS) were compared between the risk groups assigned by the BCT score.ResultsA total of 712 patients were eligible for analysis. The median follow-up time was 7.47 years. The BCT score was prognostic in patients aged ≤50 years (n = 404) and those aged >50 years (n = 308). In both age groups, the 10-year DMFS and DFS rates for patients classified as high risk by the BCT score were significantly lower than those for patients classified as low risk. A multivariate analysis revealed that the BCT score was an independent prognostic factor for DFS in patients aged ≤50 years (hazard ratio, 1.28; 95% CI, 1.05–1.56; P = 0.015), as well as those aged >50 years.ConclusionThe BCT score could be used to identify low-risk patients who will not benefit from adjuvant chemotherapy to treat HR+/HER2− early breast cancer regardless of age. A further prospective study to assess the prognostic and predictive value of the BCT score is required.
Highlights
Young age at diagnosis is a negative prognostic factor for patients with early breast cancer, those with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) breast cancer [1,2,3]
When we compared the clinical characteristics of patients by age group, we found no significant differences in tumor size, pathologic nodal (pN), nuclear grade, histologic grade, or Ki-67 between age groups (Table 1)
When we compared the Breast Cancer Test (BCT) score distribution and clinicopathological parameters according to age group, we found that younger patients had tumors with higher lymphovascular invasion (LVI) and that a higher percentage of young patients was classified into the BCT high-risk group than older patients
Summary
Young age at diagnosis is a negative prognostic factor for patients with early breast cancer, those with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) breast cancer [1,2,3]. Recent TAILORx results show that the Oncotype DX recurrence score (RS) has different treatment implications for patients aged ≤50 and those aged >50 years [14], and they further revealed that the clinical risk classification in combination with RS provided prognostic information for identifying young patients who could benefit from chemotherapy [15]. Those findings raised concerns about the value of existing multigene assays for deciding whether to use adjuvant chemotherapy in young breast cancer patients. We assessed the prognostic value of the GenesWell BCT assay according to age group
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