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The Prognostic Significance of the Oncotype DX Recurrence Score in T1-2N1M0 Estrogen Receptor-Positive HER2-Negative Breast Cancer Based on the Prognostic Stage in the Updated AJCC 8th Edition

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the prognostic significance of the Oncotype DX recurrence score (RS) in T1-2N1M0 estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer based on the prognostic stage in the updated American Joint Commission on Cancer, 8th edition.

Methods

The Surveillance, Epidemiology, and End Results database was searched to identify ER-positive invasive ductal breast cancer in T1-2N1M0 with RS results diagnosed between 2004 and 2012. Patients with RS were categorized into low-risk (RS < 11), intermediate-risk (RS 11–25), and high-risk (RS > 25) groups. The distributions of clinical-pathological characteristics were compared among the RS risk groups using Pearson’s Chi square. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared across RS groups using the log-rank statistic. Cox models were fitted to assess the factors independently associated with survival.

Results

The study enrolled 4059 cases categorized into prognostic stages IA to IIB. The RS risk groups were positively correlated with pathological prognostic stages (P < 0.001). The RS risk groups differed significantly in terms of BCSS and OS (P < 0.001). According to the multivariate analysis, RS risk group was an independent prognostic factor for BCSS and OS together with the pathological prognostic stage. The subgroup analysis showed similar survival rates across pathological prognostic stages in the RS low-risk group but significant differences in survival rates among pathological prognostic stages in the RS intermediate-risk group. The survival rates among the RS risk groups also differed significantly in pathological prognostic stage IA.

Conclusions

Oncotype DX RS provided independent prognostic significance to complement the prognostic staging system.

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References

  1. Giuliano AE, Edge SB, Hortobagyi GN. Eighth edition of the AJCC cancer staging manual: breast cancer. Ann Surg Oncol. 2018;25:1783–5.

    Article  PubMed  Google Scholar 

  2. Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 2004;351:2817–26.

    Article  CAS  Google Scholar 

  3. Kwa M, Makris A, Esteva FJ. Clinical utility of gene-expression signatures in early stage breast cancer. Nature Rev Clin Oncol. 2017;14:595–610.

    Article  CAS  Google Scholar 

  4. Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24:3726–34.

    Article  CAS  Google Scholar 

  5. Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379:111–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 2015;373:2005–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Curtit E, Mansi L, Maisonnette-Escot Y, Sautiere JL, Pivot X. Prognostic and predictive indicators in early-stage breast cancer and the role of genomic profiling: focus on the Oncotype DX([R]) breast recurrence score assay. Eur J Surg Oncol. 2017;43:921–30.

    Article  CAS  PubMed  Google Scholar 

  8. Albain KS, Barlow WE, Shak S, et al. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial. Lancet Oncol. 2010;11:55–65.

    Article  CAS  PubMed  Google Scholar 

  9. Dowsett M, Cuzick J, Wale C, et al. Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study. J Clin Oncol. 2010;28:1829–34.

    Article  PubMed  Google Scholar 

  10. Gluz O, Nitz UA, Christgen M, et al. West German Study Group Phase III PlanB Trial: first prospective outcome data for the 21-gene recurrence score assay and concordance of prognostic markers by central and local pathology assessment. J Clin Oncol. 2016;34:2341–9.

    Article  PubMed  Google Scholar 

  11. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 1. 2018. Retrieved at http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 20 Mar 2018.

  12. Harris LN, Ismaila N, McShane LM, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34:1134–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2015;26(Suppl 5):v8–30.

    Article  PubMed  Google Scholar 

  14. Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies: improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol. 2015;26:1533–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Stemmer SM, Steiner M, Rizel S, et al. Clinical outcomes in ER+ HER2 -node-positive breast cancer patients who were treated according to the Recurrence Score results: evidence from a large prospectively designed registry. NPJ Breast Cancer. 2017;3:32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Petkov VI, Miller DP, Howlader N, et al. Breast cancer-specific mortality in patients treated based on the 21-gene assay: a SEER population-based study. NPJ Breast Cancer. 2016;2:16017.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Roberts MC, Miller DP, Shak S, Petkov VI. Breast cancer-specific survival in patients with lymph node-positive hormone receptor-positive invasive breast cancer and Oncotype DX Recurrence Score results in the SEER database. Breast Cancer Res Treat. 2017;163:303–10.

    Article  PubMed  Google Scholar 

  18. Nitz U, Gluz O. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res Treat. 2017;165:573–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Penault-Llorca F, Filleron T, Asselain B, et al. The 21-gene Recurrence Score(R) assay predicts distant recurrence in lymph node-positive, hormone receptor-positive, breast cancer patients treated with adjuvant sequential epirubicin- and docetaxel-based or epirubicin-based chemotherapy (PACS-01 trial). BMC Cancer. 2018;18:526.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wong WB, Ramsey SD, Barlow WE, Garrison LP Jr, Veenstra DL. The value of comparative effectiveness research: projected return on investment of the RxPONDER trial (SWOG S1007). Contemp Clin Trials. 2012;33:1117–23.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sparano JA, Paik S. Development of the 21-gene assay and its application in clinical practice and clinical trials. J Clin Oncol. 2008;26:721–8.

    Article  PubMed  Google Scholar 

  22. Cardoso F, van’t Veer LJ, Bogaerts J, et al. 70-Gene Signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016;375:717–29.

    Article  CAS  Google Scholar 

  23. Stemmer SM, Klang SH, Ben-Baruch N, et al. The impact of the 21-gene Recurrence Score assay on clinical decision making in node-positive (up to 3 positive nodes) estrogen receptor-positive breast cancer patients. Breast Cancer Res Treat. 2013;140:83–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Torres S, Trudeau M, Gandhi S, et al. Prospective evaluation of the impact of the 21-gene recurrence score assay on adjuvant treatment decisions for women with node-positive breast cancer in Ontario, Canada. Oncologist. 2018;23:768–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China

    Maoli Wang MS, Kejin Wu MD, Peng Zhang MD, Mingdi Zhang MD, Ang Ding MD & Hongliang Chen MD

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  1. Maoli Wang MS
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  2. Kejin Wu MD
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  3. Peng Zhang MD
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  4. Mingdi Zhang MD
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  5. Ang Ding MD
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  6. Hongliang Chen MD
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Correspondence to Hongliang Chen MD.

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Wang, M., Wu, K., Zhang, P. et al. The Prognostic Significance of the Oncotype DX Recurrence Score in T1-2N1M0 Estrogen Receptor-Positive HER2-Negative Breast Cancer Based on the Prognostic Stage in the Updated AJCC 8th Edition. Ann Surg Oncol 26, 1227–1235 (2019). https://doi.org/10.1245/s10434-018-7068-3

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  • DOI: https://doi.org/10.1245/s10434-018-7068-3

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