Journal Article
. 2020 Jul;20(2).
doi: 10.3892/ol.2020.11734.

Clinicopathological characteristics, adjuvant chemotherapy decision and disease outcome in patients with breast cancer with a 21-gene recurrence score of 26-30

Jing Yu 1 Jiayi Wu 1 Ou Huang 1 Jianrong He 1 Li Zhu 1 Weiguo Chen 1 Yafen Li 1 Xiaosong Chen 1 Kunwei Shen 1 
Affiliations
  • PMID: 32724396
  •     35 References

Abstract

Recurrence score (RS) could be used to predict clinical outcomes and chemotherapy efficacy in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative and lymph node-negative breast cancer. However, the clinical features and management of patients with an RS of 26-30 are not completely understood. In the present study, 783 patients with HR+/HER2-, lymph node-negative early breast cancer and RS ≥18 were included and categorized into RS=18-25 (47.8%), 26-30 (25.5%) or ≥31 (26.7%) groups. Clinicopathological characteristics, adjuvant chemotherapy usage and disease outcomes were compared. Alterations in the adjuvant chemotherapy recommendation after 21-gene RS testing were also analyzed. The results indicated that patients with RS=26-30 had higher progesterone receptor (PR) expression [odds ratio (OR)=2.84; P<0.001] and lower Ki-67 index (OR, 1.88; P=0.032) compared with patients with RS ≥31. Multivariate analysis demonstrated that age ≤50 years (OR, 5.75; P=0.001) and luminal-B subtype (OR, 7.75; P<0.001) were factors that were independently associated with chemotherapy usage in the RS=26-30 group. Among 104 patients who were not recommended chemotherapy before 21-gene RS testing, the treatment decision for 52 patients was changed to recommend chemotherapy once an RS of 26-30 was identified. The patient adherence rate to the treatment recommendation was 95.0% (190/200). After a median follow-up of 21.5 months, 6 patients displayed disease recurrence in the RS=26-30 group, and there was no significant difference between patients receiving chemotherapy and patients not receiving chemotherapy. In conclusion, patients with RS=26-30 had tumors with higher PR expression and lower Ki-67 index compared with those of patients with RS ≥31. Age, luminal subtype and RS testing influenced chemotherapy usage in patients with RS=26-30; however, no significant benefit from adjuvant chemotherapy was observed in a short term of 2 years.

Keywords: 21-gene recurrence score; adjuvant chemotherapy; breast cancer; disease outcome; multidisciplinary team.

Distribution patterns of 21-gene recurrence score in 980 Chinese estrogen receptor-positive, HER2-negative early breast cancer patients.
Jiayi Wu, Yan Fang, +11 authors, Kunwei Shen.
Oncotarget, 2017 Apr 14; 8(24). PMID: 28404972    Free PMC article.
NCCN Guidelines Insights: Breast Cancer, Version 3.2018.
Matthew P Goetz, William J Gradishar, +30 authors, Rashmi Kumar.
J Natl Compr Canc Netw, 2019 Feb 23; 17(2). PMID: 30787125
Highly Cited.
Breast-cancer-specific mortality in patients treated based on the 21-gene assay: a SEER population-based study.
Valentina I Petkov, Dave P Miller, +21 authors, Steven Shak.
NPJ Breast Cancer, 2017 Jul 20; 2. PMID: 28721379    Free PMC article.
Highly Cited.
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.
Oleg Gluz, Ulrike A Nitz, +18 authors, Nadia Harbeck.
J Clin Oncol, 2016 Mar 02; 34(20). PMID: 26926676
Highly Cited.
Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG), R Peto, +15 authors, K Pritchard.
Lancet, 2011 Dec 14; 379(9814). PMID: 22152853    Free PMC article.
Highly Cited.
Clinical utility of gene-expression signatures in early stage breast cancer.
Maryann Kwa, Andreas Makris, Francisco J Esteva.
Nat Rev Clin Oncol, 2017 Jun 01; 14(10). PMID: 28561071
Highly Cited. Review.
Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG).
Lancet, 2005 May 17; 365(9472). PMID: 15894097
Highly Cited.
Tumor grade and progesterone receptor status predict 21-gene recurrence score in early stage invasive breast carcinoma.
Jing Li Huang, Scott Kizy, +5 authors, Jane Yuet Ching Hui.
Breast Cancer Res Treat, 2018 Sep 10; 172(3). PMID: 30196425
Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy: A Secondary Analysis of the TAILORx Randomized Clinical Trial.
Joseph A Sparano, Robert J Gray, +26 authors, George W Sledge.
JAMA Oncol, 2019 Oct 01; 6(3). PMID: 31566680    Free PMC article.
Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +27 authors, George W Sledge.
N Engl J Med, 2018 Jun 05; 379(2). PMID: 29860917    Free PMC article.
Highly Cited.
Impact of 70-Gene Signature Use on Adjuvant Chemotherapy Decisions in Patients With Estrogen Receptor-Positive Early Breast Cancer: Results of a Prospective Cohort Study.
Anne Kuijer, Marieke Straver, +8 authors, Thijs van Dalen.
J Clin Oncol, 2017 Aug 17; 35(24). PMID: 28813638
Pooled analysis of prospective European studies assessing the impact of using the 21-gene Recurrence Score assay on clinical decision making in women with oestrogen receptor-positive, human epidermal growth factor receptor 2-negative early-stage breast cancer.
Joan Albanell, Christer Svedman, +6 authors, Wolfgang Eiermann.
Eur J Cancer, 2016 Aug 22; 66. PMID: 27544930
Clinical outcomes in patients with node-negative breast cancer treated based on the recurrence score results: evidence from a large prospectively designed registry.
Salomon M Stemmer, Mariana Steiner, +21 authors, Nicky Liebermann.
NPJ Breast Cancer, 2017 Sep 14; 3. PMID: 28900633    Free PMC article.
21-Gene recurrence score decreases receipt of chemotherapy in ER+ early-stage breast cancer: an analysis of the NCDB 2010-2013.
Benjamin M Parsons, Jeffrey Landercasper, +3 authors, Leah L Dietrich.
Breast Cancer Res Treat, 2016 Aug 11; 159(2). PMID: 27507245    Free PMC article.
Community clinical practice patterns and mortality in patients with intermediate oncotype DX recurrence scores: Who benefits from chemotherapy?
Abiola F Ibraheem, David J Press, Olufunmilayo I Olopade, Dezheng Huo.
Cancer, 2018 Nov 06; 125(2). PMID: 30387876    Free PMC article.
The impact of the Oncotype Dx breast cancer assay in clinical practice: a systematic review and meta-analysis.
Josh J Carlson, Joshua A Roth.
Breast Cancer Res Treat, 2013 Aug 27; 141(1). PMID: 23974828    Free PMC article.
Highly Cited. Systematic Review.
A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.
Soonmyung Paik, Steven Shak, +12 authors, Norman Wolmark.
N Engl J Med, 2004 Dec 14; 351(27). PMID: 15591335
Highly Cited.
21-Gene Recurrence Score Assay As a Predictor of Adjuvant Chemotherapy Administration for Early-Stage Breast Cancer: An Analysis of Use, Therapeutic Implications, and Disparity Profile.
Jagar Jasem, Arya Amini, +4 authors, Peter Kabos.
J Clin Oncol, 2016 Mar 24; 34(17). PMID: 27001563    Free PMC article.
Adjuvant chemotherapy and survival among patients 70 years of age and younger with node-negative breast cancer and the 21-gene recurrence score of 26-30.
Seho Park, Yunan Han, +7 authors, Yikyung Park.
Breast Cancer Res, 2019 Oct 18; 21(1). PMID: 31619259    Free PMC article.
Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013.
A Goldhirsch, E P Winer, +5 authors, Panel members.
Ann Oncol, 2013 Aug 07; 24(9). PMID: 23917950    Free PMC article.
Highly Cited.
High-Risk Premenopausal Luminal A Breast Cancer Patients Derive no Benefit from Adjuvant Cyclophosphamide-based Chemotherapy: Results from the DBCG77B Clinical Trial.
Torsten O Nielsen, Maj-Brit Jensen, +4 authors, Bent Ejlertsen.
Clin Cancer Res, 2016 Sep 08; 23(4). PMID: 27601592
Is Age Trumping Genetic Profiling in Clinical Practice? Relationship of Chemotherapy Recommendation and Oncotype DX Recurrence Score in Patients Aged < 50 Years versus ≥ 50 Years, and Trends Over Time.
Austin D Williams, Sylvia A Reyes, +2 authors, Lucy M De La Cruz.
Ann Surg Oncol, 2018 Jul 01; 25(10). PMID: 29959613
Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.
Soonmyung Paik, Gong Tang, +11 authors, Norman Wolmark.
J Clin Oncol, 2006 May 25; 24(23). PMID: 16720680
Highly Cited.
Relationship of histologic grade and histologic subtype with oncotype Dx recurrence score; retrospective review of 863 breast cancer oncotype Dx results.
Kamaljeet Singh, Xin He, +3 authors, C James Sung.
Breast Cancer Res Treat, 2017 Dec 13; 168(1). PMID: 29230662
Prospective Validation of a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +28 authors, George W Sledge.
N Engl J Med, 2015 Sep 29; 373(21). PMID: 26412349    Free PMC article.
Highly Cited.
Association of 70-Gene Signature Assay Findings With Physicians' Treatment Guidance for Patients With Early Breast Cancer Classified as Intermediate Risk by the 21-Gene Assay.
Michaela Tsai, Shelly Lo, +11 authors, Hatem Soliman.
JAMA Oncol, 2017 Oct 28; 4(1). PMID: 29075751    Free PMC article.
A nomogram to predict adjuvant chemotherapy recommendation in breast cancer patients with intermediate recurrence score.
Feilin Qu, Xiaosong Chen, +10 authors, Kunwei Shen.
Chin J Cancer Res, 2018 Jun 05; 30(2). PMID: 29861607    Free PMC article.
The impact of the 21-gene assay on adjuvant treatment decisions in oestrogen receptor-positive early breast cancer: a prospective study.
Anna Kuchel, Tim Robinson, +8 authors, Jeremy P Braybrooke.
Br J Cancer, 2016 Mar 10; 114(7). PMID: 26954715    Free PMC article.
Clinical and Genomic Risk to Guide the Use of Adjuvant Therapy for Breast Cancer.
Joseph A Sparano, Robert J Gray, +27 authors, George W Sledge.
N Engl J Med, 2019 Jun 04; 380(25). PMID: 31157962    Free PMC article.
Highly Cited.
Utilization and impact of 21-gene recurrence score assay for breast cancer in clinical practice across the United States: lessons learned from the 2010 to 2012 National Cancer Data Base analysis.
Amila Orucevic, Robert E Heidel, John L Bell.
Breast Cancer Res Treat, 2016 May 22; 157(3). PMID: 27206678    Free PMC article.
Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features.
Lori J Goldstein, Robert Gray, +12 authors, Joseph A Sparano.
J Clin Oncol, 2008 Aug 06; 26(25). PMID: 18678838    Free PMC article.
Highly Cited.
Global cancer statistics, 2012.
Lindsey A Torre, Freddie Bray, +3 authors, Ahmedin Jemal.
CA Cancer J Clin, 2015 Feb 06; 65(2). PMID: 25651787
Highly Cited.
Statistics for surgeons - understanding survival analysis.
Girdhar Gopal Agarwal.
Indian J Surg Oncol, 2013 Sep 03; 3(3). PMID: 23997508    Free PMC article.
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.
Kathy S Albain, William E Barlow, +20 authors, Breast Cancer Intergroup of North America.
Lancet Oncol, 2009 Dec 17; 11(1). PMID: 20005174    Free PMC article.
Highly Cited.
Prospective Evaluation of the 21-Gene Recurrence Score Assay for Breast Cancer Decision-Making in Ontario.
Mark N Levine, Jim A Julian, +5 authors, Kathleen I Pritchard.
J Clin Oncol, 2015 Nov 26; 34(10). PMID: 26598746