复发评分可以预测新辅助化疗效果

二十一基因复发评分可以预测临床

淋巴结阴性乳腺癌新辅助化疗效果

　　21基因（Oncotype DX）复发评分已被证实可以预测淋巴结阴性乳腺癌患者的远处复发风险和无病生存，有助于指导术后辅助化疗决策。不过，尚不明确复发评分是否有助于指导术前新辅助化疗决策。

　　2018年12月12日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学报》在线发表哈佛大学医学院、贝斯以色列医院和新英格兰女执事医院的研究报告，对21基因复发评分预测新辅助化疗效果进行了探讨。

　　该研究通过全国癌症数据库对2010～2015年所有被诊断为T1～T3期、雌激素受体阳性、HER2阴性、有21基因复发评分、接受了新辅助化疗的原发性浸润性乳腺癌患者进行回顾分析，按其复发评分归类为低、中、高。通过未校正和校正的回归分析，确定病理完全缓解和复发评分之间的相关性。

　　结果，共计989例患者（平均年龄54.6岁）有复发评分并且接受了新辅助化疗。复发评分低、中、高的患者分别为227例（23.0%）、450例（45.5%）、312例（31.5%）。大多数患者的肿瘤分期为T1期（431例，43.6%）或T2期（451例，45.6%）。大多数患者的淋巴结为阴性（757例，76.5%）。肿瘤分级为1级（123例，12.4%）、2级（517例，52.3%）或3级（349例，35.3%）。获得病理完全缓解患者42例（4.3%）。

　　校正后的多因素逻辑回归分析表明，病理完全缓解与复发评分高之间存在显著相关性（比值比：4.87，95%置信区间：2.01～11.82）。

　　因此，该全国队列研究结果表明，对于雌激素受体阳性、HER2阴性乳腺癌患者，复发评分与新辅助化疗后的病理完全缓解相关，21基因检测有助于确定最适合新辅助化疗的患者，并且应该考虑将其纳入多学科决策流程。

Ann Surg Oncol. 2018 Dec 12. [Epub ahead of print]

Oncotype DX Recurrence Score as a Predictor of Response to Neoadjuvant Chemotherapy.

Pease AM, Riba LA, Gruner RA, Tung NM, James TA.

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.

BACKGROUND: The Oncotype DX assay has been validated in predicting response to adjuvant chemotherapy in breast cancer. Its role in neoadjuvant chemotherapy (NCT) has not been established.

METHODS: The National Cancer Database was used to identify all patients with T1-T3, ER-positive, HER2-negative primary invasive breast cancer diagnosed from 2010 to 2015 who had Oncotype DX recurrence scores (RS) and received NCT. RS were classified as low, intermediate, or high. Unadjusted and adjusted regression analyses were performed to determine the association between pathologic complete response (pCR) and RS.

RESULTS: A total of 989 patients (mean age, 54.6 years) with available RS who underwent NCT were identified. RS were low in 227 (23.0%) patients, intermediate in 450 (45.5%) patients, and high in 312 (31.5%) patients. Most patients had a T1 (431 [43.6%]) or T2 tumor (451 [45.6%]). Most had N0 disease (757 [76.5%]). Tumor grades were 1 (123 [12.4%]), 2 (517 [52.3%]), or 3 (349 [35.3%]). pCR was achieved by 42 (4.3%) patients. Adjusted multivariable analysis showed a significant association between pCR and high RS (odds ratio 4.87; 95% confidence interval 2.01-11.82).

CONCLUSIONS: High Oncotype DX RS was associated with pCR after NCT in this national cohort of ER-positive, HER2-negative patients. Oncotype DX testing could help to identify patients most suited for NCT and should be considered for incorporation into the multidisciplinary decision-making process.

PMID: 30542840

DOI: 10.1245/s10434-018-07107-8