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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2018.611    [Accepted]
Impact of 21-Gene Recurrence Score on Chemotherapy Decision in Invasive Ductal Carcinoma of Breast with Nodal Micrometastases
Wei-Rong Chen1, Jia-Peng Deng2, Jun Wang3, Jia-Yuan Sun2, Zhen-Yu He2, San-Gang Wu3
1Department of Breast Surgery, Zhuhai Maternity and Child Health Hospital, Zhuhai, China
2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
3Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
Correspondence  Zhen-Yu He ,Tel: 86-20-87343543, Fax: 86-20-87343392, Email: hezhy@sysucc.org.cn
San-Gang Wu ,Tel: 86-592-2139531, Fax: 86-592-2137322, Email: unowu12345@hotmail.com
Received: November 7, 2018;  Accepted: March 1, 2019.  Published online: March 4, 2019.
*Wei-Rong Chen and Jia-Peng Deng contributed equally to this work.
ABSTRACT
Purpose
The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC).
Method
Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed.
Results
We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2 negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs.
Conclusion
The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.
Key words: Breast neoplasms, Surgery, Drug therapy
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