21-Gene Assay and Breast Cancer Mortality in Ductal Carcinoma In Situ
| Autor: | Eileen Rakovitch, Rinku Sutradhar, Cindy Fong, S. Gu, Lawrence Paszat, Wedad Hanna, Sharon Nofech-Mozes |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty medicine.medical_treatment Population Breast Neoplasms Mastectomy Segmental Competing risks 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine medicine Breast-conserving surgery Humans 030212 general & internal medicine education Aged Proportional Hazards Models education.field_of_study Oncotype DX Breast Cancer Assay business.industry Carcinoma Ductal Breast Middle Aged Ductal carcinoma Prognosis medicine.disease Confidence interval Radiation therapy Carcinoma Intraductal Noninfiltrating 030220 oncology & carcinogenesis Female Neoplasm Recurrence Local business |
| Zdroj: | JNCI: Journal of the National Cancer Institute. 113:572-579 |
| ISSN: | 1460-2105 0027-8874 |
| DOI: | 10.1093/jnci/djaa179 |
| Popis: | Background The inability to identify individuals with ductal carcinoma in situ (DCIS) who are at risk of breast cancer (BC) mortality have hampered efforts to reduce the overtreatment of DCIS. The 21-gene recurrence score (RS) predicts distant metastases for individuals with invasive BC, but its prognostic utility in DCIS is unknown. Methods We performed a population-based analysis of 1362 individuals of DCIS aged 75 years or younger at diagnosis treated with breast-conserving therapy. We examined the association between a high RS (defined a priori as >25) and the risk of BC mortality by using a propensity score-adjusted model accounting for the competing risk of death from other causes, testing for interactions. All statistical tests were 2-sided. Results With 16 years median follow-up, 36 (2.6%) died of BC, and 200 (14.7%) died of other causes. The median value of the RS was 15 (range = 0-84); 29.6% of individuals had a high RS. A high RS was associated with an 11-fold increased risk of BC mortality (hazard ratio = 11.27, 95% confidence interval [CI] = 3.00 to 42.33; P < .001) in women aged 50 years or younger at diagnosis treated with breast-conserving surgery alone, culminating in a 9.4% (95% CI = 2.3% to 22.5%) 20-year risk of BC death. For women with a high RS, treatment with radiotherapy was associated with a 71% (hazard ratio = 0.29, 95% CI = 0.10 to 0.89; P = .03) relative and a 5% absolute reduction in the 20-year cumulative risk of death from BC. Conclusion The 21-gene RS predicts BC mortality in DCIS and combined with age (50 years or younger) at diagnosis can identify individuals for whom radiotherapy reduces the risk of death from BC. |
| Databáze: | OpenAIRE |
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