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Tsuchida Y, Niikura N, Chishima T, Mizuno M, Kawate T, Fuchikami H, Miyoshi Y, Sakai T, Kotani H, Kondo N, Hayashi N. Correlation between postoperative treatment selection and prognosis determined using the Oncotype DX® test data: a retrospective multicenter study in Japan. Breast Cancer 2024; 31:401-408. [PMID: 38451415 DOI: 10.1007/s12282-024-01548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Oncotype DX® is a frequently used multigene assay for hormone receptor-positive breast cancers. However, limited evidence is available regarding its application in Japan owing to the lack of insurance coverage. Therefore, we conducted this large-scale, retrospective study by collecting data from nine Japanese institutes and assessed postoperative treatment choice and prognosis by using Oncotype DX®. METHODS Six hundred thirty-two patients who underwent breast surgery and whose recurrence score (RS) data were available were included. They were divided into RS 0-25 and RS ≥ 26 groups. The groups were compared in terms of clinicopathological factors, treatment options, and prognosis. RESULTS After the median follow-up period of 10.1 years, the disease-free survival (DFS) rates were significantly better in the RS 0-25 group (p = 0.02). Per the recurrent event type, there was no significant intergroup difference in locoregional recurrence (p = 0.139). However, a trend toward better distant DFS was observed in the RS 0-25 group (p = 0.08). Overall survival was also significantly better in this group (p = 0.027). Considering chemotherapy use, DFS worsened among chemotherapy-treated patients with an RS of 0-25 and those with an RS ≥ 26 who did not receive chemotherapy (p < 0.001). Seven (1.35%) chemotherapy-treated patients with an RS of 0-25 showed disease recurrence. CONCLUSIONS This study presents the largest database-derived prognostic data in Japanese patients, utilizing the Oncotype DX® treatment selection. Further studies are needed to determine the impact on treatment choice, considering the clinical risk, and the need for additional postoperative treatment.
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Affiliation(s)
- Yasue Tsuchida
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takashi Chishima
- Department of Breast Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
- Division of Breast Surgical Oncology, Department of Surgery, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Mari Mizuno
- Department of Breast Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takahiko Kawate
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiromi Fuchikami
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan
| | - Yasuo Miyoshi
- Division of Breast and Endocrine Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takehiko Sakai
- Department of Breast Oncology Center, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Hayashi
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, 1-5-8, Hatanodai, Shinahawa-ku, Tokyo, 142-8666, Japan.
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Chevli N, Haque W, Tran KT, Farach AM, Schwartz MR, Hatch SS, Butler EB, Teh BS. 21-Gene recurrence score predictive for prognostic benefit of radiotherapy in patients age ≥ 70 with T1N0 ER/PR + HER2- breast cancer treated with breast conserving surgery and endocrine therapy. Radiother Oncol 2022; 174:37-43. [PMID: 35772577 DOI: 10.1016/j.radonc.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Based on the results of the Cancer and Leukemia Group B (CALGB) 9343 trial, patients age ≥70 with T1N0 hormone receptor positive (ER/PR+), human epidermal growth factor receptor-2 negative (HER2-) breast cancer who are treated with breast conserving surgery (BCS) and endocrine therapy (ET) are candidates for omission of radiotherapy (RT). Because the CALGB 9343 trial did not stratify based on recurrence score (RS) test (Oncotype Dx), we conducted the present retrospective study to determine whether RS is predictive of who may benefit from RT following BCS in this cohort. MATERIALS AND METHODS The National Cancer Database (NCDB) was queried (2004-2017) for patients age ≥ 70 with pT1N0 ER+/PR + HER2- breast cancer treated with BCS and ET. Patients were stratified based on their RS (low risk [LR] = 1-10, intermediate risk [IR] = 11-25, high risk [HR] = 26-99). Propensity score matching (PSM) created 1:1 matched cohorts of patients who received radiotherapy and those who did not. Kaplan-Meier analysis evaluated overall survival (OS). Univariable (UVA) and multivariable (MVA) Cox proportional hazard analyses identified clinical and treatment factors prognostic for OS. RESULTS A total of 11,891 patients met the selection criteria: 3364 in the LR cohort, 7305 in the IR cohort, and 1222 in the HR cohort. A total of 79 % received RT: 77 % in the LR cohort, 79 % in the IR cohort, and 85 % in the HR cohort. Because PSM could not be efficiently performed in the HR cohort alone, the IR and HR cohort were merged (IRHR) for matching. After PSM, the 5-year OS in the LR cohort was 91 % for those who received RT and 89 % for those who did not (p = 0.605). In the IRHR cohort, the 5-year OS was 91 % for those who received RT and 87 % for those who did not (p = 0.003). On MVA in the LR cohort, RT (p = 0.727) was not predictive of improved OS. On MVA in the IRHR cohort, RT (p = 0.010) was a positive prognostic factor for OS. CONCLUSION In this older cohort of patients, there is an OS benefit with the use of RT in patients with IRHR RS but not in patients with LR RS. Pending prospective evaluation, assessment of RS in this older subset of patients is recommended with consideration of RT when RS is ≥11.
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Affiliation(s)
- Neil Chevli
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, United States
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - Kevin T Tran
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, United States
| | - Andrew M Farach
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - Mary R Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, United States
| | - Sandra S Hatch
- Department of Radiation Oncology, MD Anderson Cancer Center, United States
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, United States.
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Weiser R, Haque W, Polychronopoulou E, Hatch SS, Kuo YF, Gradishar WJ, Klimberg VS. The 21-gene recurrence score in node-positive, hormone receptor-positive, HER2-negative breast cancer: a cautionary tale from an NCDB analysis. Breast Cancer Res Treat 2020; 185:667-676. [PMID: 33070279 DOI: 10.1007/s10549-020-05971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The 21-gene recurrence score assay (RS) has not been prospectively validated to predict adjuvant chemotherapy benefit in hormone receptor-positive (HR+), HER2-negative (HER2-), node-positive breast cancer patients. Nevertheless, de-escalation based on RS has been demonstrated and partially advocated by retrospective data. The purpose of this study was to identify subgroups of node-positive patients with low to intermediate RS who still benefit from adjuvant chemotherapy. METHODS The National Cancer Database was used to identify 28,591 women with stage I-III, T1-T3, N1, HR+, HER2- breast cancer and a RS ≤ 25 between 2010 and 2016. Univariate and multivariate analyses were used to identify variables correlating with chemotherapy use and 5-year survival. Subgroup analysis was performed to discern patients in whom the use of adjuvant chemotherapy correlated with better survival. RESULTS A 35% decline in chemotherapy use was observed from 2010 to 2016. Patients with younger age, higher RS, larger tumors and more positive lymph nodes, and those treated by mastectomy, axillary lymph node dissection and radiation, were more likely to receive chemotherapy. Chemotherapy use was associated with an improved 5-year survival (HR = 1.63, 95% CI 1.28-2.07). Upon subgroup analysis, this association was lost in patients > 70 years and those with a RS ≤ 11, while patients ≤ 70 with a RS of 12-25 treated with chemotherapy had an absolute 5-year survival advantage of 3.0% (HR = 1.91, 95% CI 1.42-2.57). CONCLUSION Clinicians should be cautious when considering omission of adjuvant chemotherapy in patients ≤ 70 years, with HR+, HER2-, N1 tumors and a RS 12-25, at least until the results of the anticipated RxPONDER trial become available.
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Affiliation(s)
- Roi Weiser
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Efstathia Polychronopoulou
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Gradishar
- Department of Medicine & Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
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Singh P, Tevis SE, Hall CS, Meas S, Hwang RF, Lucci A. Correlation of circulating or disseminated tumor cells with the Oncotype DX Recurrence Score. Breast Cancer Res Treat 2020; 184:683-687. [PMID: 32888140 DOI: 10.1007/s10549-020-05882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/13/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE New biomarkers are emerging to predict recurrence risk in women with early-stage breast cancer. High Oncotype DX Recurrence Score® (RS) is associated with worse disease-free and overall survival. Similarly, circulating tumor cells (CTCs, blood) and disseminated tumor cells (DTCs, bone marrow) have prognostic value in breast cancer. We investigated the association between high RS and CTCs or DTCs. METHODS Using a prospective database, we evaluated patients with hormone receptor-positive/HER2-negative, node-negative invasive breast cancer from 1/2005 to 1/2017. RS was classified using TAILORx study cutoff points: low (< 11), intermediate (11-25), and high (> 25). CTCs were assessed using CellSearch® and DTCs using cytospin specimens of bone marrow aspirates. Positive result was defined as one or more CTCs or DTCs identified. Chi-square analyses were utilized to evaluate the relationship between RS and CTCs or DTCs. RESULTS 233 patients were identified from a prospective database, of which 96 had RS results. Of these patients, 88 had CTC results and 58 had DTC results. CTCs were detected in 17/88 (19%) patients, while DTCs were detected in 20/58 (34%). Patients with high RS were not more likely to have CTCs (18%) compared to patients with low/intermediate RS (20%; p = 0.919). Similarly, high RS was not associated with DTC detection, with DTCs present in 40% of patients with high RS versus 33% with low/intermediate RS (p = 0.687). In the subgroup of patients ≤ 50 years, no associations were found between high RS and CTCs (p = 0.383) or DTCs (p = 0.234). CONCLUSIONS High Oncotype DX RS did not correlate with CTCs in blood or DTCs in bone marrow in our study.
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Affiliation(s)
- Puneet Singh
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Sarah E Tevis
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Carolyn S Hall
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Salyna Meas
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Rosa F Hwang
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Schreuder K, Kuijer A, Bentum S, van Dalen T, Siesling S. Use and Impact of the 21-Gene Recurrence Score in Relation to the Clinical Risk of Developing Metastases in Early Breast Cancer Patients in the Netherlands. Public Health Genomics 2019; 21:85-92. [PMID: 30650410 DOI: 10.1159/000495742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/23/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The nationwide use of the 21-gene recurrence score (21-RS) and implications regarding chemotherapy administration in relation to clinical risk in early breast cancer patients are investigated. METHODS Breast cancer patients surgically treated between 2014 and 2016 were selected from the Netherlands Cancer Registry and categorized as having a clinical low, intermediate, or high risk of developing metastases. Deployment of the 21-RS is advocated in patients with an intermediate risk of developing metastases. The use and impact of the 21-RS test result on chemotherapy administration were assessed in relation to the clinical risk as well as patient and tumor characteristics; χ2 tests were used for analysis. RESULTS Of all patients, 20,488 were considered as clinical low-, 4,309 as intermediate-, and 15,266 as high-risk patients. The 21-RS was deployed in 0.1% (n = 23), 3.2% (n = 137), and 0.6% (n = 90) of these categories, respectively. In the clinical intermediate-risk group, the 21-RS assigned 73.7, 13.1, and 13.1% of patients to the genomic low-, intermediate-, and high-risk category, respectively. Adherence to the 21-RS was 95.6% in these patients. CONCLUSION In the Netherlands, the 21-RS test is applied both inside and outside the guideline-directed area. In case of discordance between the genomic and clinical risk, patients were treated in line with the result of the 21-RS.
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Affiliation(s)
- Kay Schreuder
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands, .,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands,
| | - Anne Kuijer
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sanne Bentum
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Xiao G, Meng J, Zhang J, Li G, Du N, Qin S, Wang J, Xu C, Ren H, Tang SC, Sun X. Clinical Application of Detecting 21-Gene Recurrence Score in Predicating Prognosis and Therapy Response of Patients with Breast Cancer from Two Medical Centers. Cancer Invest 2017; 35:639-646. [PMID: 29243989 DOI: 10.1080/07357907.2017.1405015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To determine the most suitable strategy in treating patients with invasive breast cancer from Northwest China. Lower recurrence score (RS) correlated with lower recurrence ratio. Patients having a medium-high 21-gene RS who received adjuvant therapy presented lower recurrence risk. Younger patients having RS results (⩾31) tended to accept adjuvant therapy more often, however, those having intermediate RS results were inclined to wait and did not receive chemotherapy. These results suggested that RS-based precision medicine will allow individualized diagnosis and treatment, resulting in better outcomes and preserved medical resources.
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Affiliation(s)
- Guodong Xiao
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
| | - Jinying Meng
- b Department of Surgery Oncology , The First People's Hospital of Xianyang City , Xianyang , Shaanxi Province , China
| | - Jing Zhang
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
| | - Gang Li
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
| | - Ning Du
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
| | - Sida Qin
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
| | - Jichang Wang
- c Department of Vascular and Endovascular Surgery , the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi Province , China
| | - Chongwen Xu
- d Department of Otorhinolaryngology , the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi Province , China
| | - Hong Ren
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
| | - Shou-Ching Tang
- e Solid Tumor Clinical Trials, Georgia Cancer Center , Medical College of Georgia, Augusta University , Augusta , Georgia , United States.,f Tianjin Medical University Cancer Institute and Hospital , Tianjin , China
| | - Xin Sun
- a Department of Thoracic Surgery and Oncology, the Second Department of Thoracic Surgery , Cancer Center, the First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi Province , China
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