Association between the 21-gene recurrence score and isolated locoregional recurrence in stage I-II, hormone receptor-positive breast cancer

David D Yang ¹, Daniela L Buscariollo ¹, Angel M Cronin ², Shicheng Weng ², Melissa E Hughes ³, Richard J Bleicher ⁴, Adam L Cohen ⁵, Sara H Javid ⁶, Stephen B Edge ⁷, Beverly Moy ¹, Joyce C Niland ⁸, Antonio C Wolff ⁹, Michael J Hassett ¹, Rinaa S Punglia ¹⁰

Affiliations

¹ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
² Division of Population Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
³ Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, 75 Francis St, Boston, MA, 02115, USA.
⁴ Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
⁵ Department of Medicine, Division of Oncology, Huntsman Cancer Institute, 1950 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
⁶ Department of Surgery, University of Washington School of Medicine, Box 356410, Seattle, WA, 98105, USA.
⁷ Department of Surgical Oncology, Roswell Park Cancer Institute, 665 Elm St, Buffalo, NY, 14203, USA.
⁸ Department of Diabetes and Cancer Discovery Science, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
⁹ Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, 401 N. Broadway, Weinberg, Baltimore, MD, 21231, USA.
¹⁰ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. rpunglia@partners.org.

PMID: 32799886
15 References

Abstract

Background: Although the 21-gene recurrence score (RS) assay is widely used to predict distant recurrence risk and benefit from adjuvant chemotherapy among women with hormone receptor-positive (HR+) breast cancer, the relationship between the RS and isolated locoregional recurrence (iLRR) remains poorly understood. Therefore, we examined the association between the RS and risk of iLRR for women with stage I-II, HR+ breast cancer.

Methods: We identified 1758 women captured in the national prospective Breast Cancer-Collaborative Outcomes Research Database who were diagnosed with stage I-II, HR+ breast cancer from 2006 to 2012, treated with mastectomy or breast-conserving surgery, and received RS testing. Women who received neoadjuvant therapy were excluded. The association between the RS and risk of iLRR was examined using competing risks regression.

Results: Overall, 19% of the cohort (n = 329) had a RS ≥25. At median follow-up of 29 months, only 22 iLRR events were observed. Having a RS ≥25 was not associated with a significantly higher risk of iLRR compared to a RS < 25 (hazard ratio 1.14, 95% confidence interval 0.39-3.36, P = 0.81). When limited to women who received adjuvant endocrine therapy without chemotherapy (n = 1199; 68% of the cohort), having a RS ≥25 (n = 74) was significantly associated with a higher risk of iLRR compared to a RS < 25 (hazard ratio 3.66, 95% confidence interval 1.07-12.5, P = 0.04). In this group, increasing RS was associated with greater risk of iLRR (compared to RS < 18, hazard ratio of 1.66, 3.59, and 7.06, respectively, for RS 18-24, 25-30, and ≥ 31; Ptrend = 0.02).

Conclusions: The RS was significantly associated with risk of iLRR in patients who did not receive adjuvant chemotherapy. The utility of the RS in identifying patients who have a low risk of iLRR should be further studied.

Keywords: Breast cancer; Locoregional recurrence; Recurrence score.

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References

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