Breast Cancer Research and Treatment

, Volume 134, Issue 2, pp 683–692

Prognostic value of biologic subtype and the 21-gene recurrence score relative to local recurrence after breast conservation treatment with radiation for early stage breast carcinoma: results from the Eastern Cooperative Oncology Group E2197 study

  • Lawrence J. Solin
  • Robert Gray
  • Lori J. Goldstein
  • Abram Recht
  • Frederick L. Baehner
  • Steven Shak
  • Sunil Badve
  • Edith A. Perez
  • Lawrence N. Shulman
  • Silvana Martino
  • Nancy E. Davidson
  • George W. SledgeJr.
  • Joseph A. Sparano
Clinical Trial


The present study was performed to evaluate the significance of biologic subtype and 21-gene recurrence score relative to local recurrence and local–regional recurrence after breast conservation treatment with radiation. Eastern Cooperative Oncology Group E2197 was a prospective randomized clinical trial that compared two adjuvant systemic chemotherapy regimens for patients with operable breast carcinoma with 1–3 positive lymph nodes or negative lymph nodes with tumor size >1.0 cm. The study population was a subset of 388 patients with known 21-gene recurrence score and treated with breast conservation surgery, systemic chemotherapy, and definitive radiation treatment. Median follow-up was 9.7 years (range = 3.7–11.6 years). The 10-year rates of local recurrence and local–regional recurrence were 5.4 % and 6.6 %, respectively. Neither biologic subtype nor 21-gene Recurrence Score was associated with local recurrence or local–regional recurrence on univariate or multivariate analyses (all P ≥ 0.12). The 10-year rates of local recurrence were 4.9 % for hormone receptor positive, HER2-negative tumors, 6.0 % for triple negative tumors, and 6.4 % for HER2-positive tumors (P = 0.76), and the 10-year rates of local–regional recurrence were 6.3, 6.9, and 7.2 %, respectively (P = 0.79). For hormone receptor-positive tumors, the 10-year rates of local recurrence were 3.2, 2.9, and 10.1 % for low, intermediate, and high 21-gene recurrence score, respectively (P = 0.17), and the 10-year rates of local–regional recurrence were 3.8, 5.1, and 12.0 %, respectively (P = 0.12). For hormone receptor-positive tumors, the 21-gene recurrence score evaluated as a continuous variable was significant for local–regional recurrence (hazard ratio 2.66; P = 0.03). The 10-year rates of local recurrence and local–regional recurrence were reasonably low in all subsets of patients. Neither biologic subtype nor 21-gene recurrence score should preclude breast conservation treatment with radiation.


Early stage breast carcinoma Breast conservation treatment Radiation treatment 21-Gene recurrence score Local recurrence Local–regional recurrence 


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Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Lawrence J. Solin
    • 1
  • Robert Gray
    • 2
    • 3
  • Lori J. Goldstein
    • 4
  • Abram Recht
    • 5
  • Frederick L. Baehner
    • 6
  • Steven Shak
    • 6
  • Sunil Badve
    • 7
  • Edith A. Perez
    • 8
  • Lawrence N. Shulman
    • 2
  • Silvana Martino
    • 9
  • Nancy E. Davidson
    • 10
  • George W. SledgeJr.
    • 11
  • Joseph A. Sparano
    • 12
  1. 1.Department of Radiation OncologyAlbert Einstein Medical CenterPhiladelphiaUSA
  2. 2.The Dana-Farber Cancer InstituteBostonUSA
  3. 3.Eastern Cooperative Oncology Group Coordinating CenterBostonUSA
  4. 4.Department of Medical OncologyFox Chase Cancer CenterPhiladelphiaUSA
  5. 5.Department of Radiation OncologyBeth Israel Deaconess Medical CenterBostonUSA
  6. 6.Genomic Health, Inc.Redwood CityUSA
  7. 7.Department of PathologyIndiana UniversityIndianapolisUSA
  8. 8.Mayo ClinicJacksonvilleUSA
  9. 9.The Angeles Clinic and Research InstituteSanta MonicaUSA
  10. 10.University of Pittsburgh Cancer InstitutePittsburghUSA
  11. 11.Department of Medical OncologyIndiana UniversityIndianapolisUSA
  12. 12.Department of Medical Oncology, Montefiore Medical CenterAlbert Einstein College of MedicineNew YorkUSA

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