Recurrence Score Testing Does not Appear to Benefit Patients With Grade 1, Progesterone Receptor-Positive Breast Cancers: An Opportunity to Eliminate Overtreatment and Decrease Testing Costs.

Autor:	Sibia US; The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA., Sanders TJ; The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA., Mylander C; The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA., Rosman M; The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA., Tweed C; The Geaton and JoAnn DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, MD, USA., Tafra L; The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA., Jackson RS; The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA.
Jazyk:	angličtina
Zdroj:	Hematology/oncology and stem cell therapy [Hematol Oncol Stem Cell Ther] 2022 Mar 01; Vol. 15 (1), pp. 44-51. Date of Electronic Publication: 2022 Mar 01.
DOI:	10.1016/j.hemonc.2021.05.005
Abstrakt:	Background: We previously described a risk prediction model (Anne Arundel Medical Center [AAMC] model) based on pathology which may eliminate the need for recurrence score (RS) testing in select early-stage breast cancers. There is a concern that patients in discordant risk prediction groups (AAMC vs. RS) may be overtreated or undertreated if RS testing were omitted. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for all breast cancer patients between 2004 and 2015. AAMC low-risk was defined as Grade 1 and progesterone receptor-positive (PR + ) tumors, while AAMC high-risk was defined as Grade 3 or estrogen-negative tumors. RS low-risk group was defined as RS < 16 and age ≤ 50 years, or RS ≤ 25 and age > 50 years. RS high-risk group was defined as RS > 25. Results: A total of 71,212 cases were analyzed. Of these, 590 were AAMC low-risk/RS high-risk discordant, while 5,596 were AAMC high-risk/RS low-risk discordant. For AAMC low-risk/RS high-risk discordant, 10-year breast cancer-specific survival (BCSS) did not differ for patients who received adjuvant chemotherapy versus those who did not (93% chemotherapy vs. 99% unknown/no chemotherapy, p = .12). Overall survival (OS) was also comparable (92% chemotherapy vs. 91% unknown/no chemotherapy, p = .42). In the AAMC high-risk/RS low-risk discordant group, 10-year BCSS (92% chemotherapy vs. 96% unknown/no chemotherapy, p = .06) and OS (87% chemotherapy vs. 90% unknown/no chemotherapy, p = .52) did not differ between adjuvant chemotherapy and unknown/no chemotherapy groups. Conclusions: Adjuvant chemotherapy in the AAMC low-risk/RS high-risk and AAMC high-risk/RS low-risk discordant groups did not improve survival. This supports consideration of omission of RS testing in Grade 1, PR + tumors. Patients with Grade 3 tumors do benefit from RS testing.
Databáze:	MEDLINE
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