Open AccessClinical outcomes in ER+ HER2 -node-positive breast cancer patients who were treated according to the Recurrence Score results: evidence from a large prospectively designed registry
Author(s) -
Salomon M. Stemmer,
Mariana Steiner,
Shulamith Rizel,
David Geffen,
Bella Nissenbaum,
Tamar Peretz,
Lior SoussanGutman,
Avital BareketSamish,
Kevin Isaacs,
Ora Rosengarten,
Georgeta Fried,
Debbie McCullough,
Christer Svedman,
Steven Shak,
Nicky Liebermann,
Noa Ben-Baruch
Publication year - 2017
Publication title -
npj breast cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.746
H-Index - 21
ISSN - 2374-4677
DOI - 10.1038/s41523-017-0033-7
Subject(s) - medicine , breast cancer , chemotherapy , medical record , cancer , surgery
The Recurrence Score® is increasingly used in node-positive ER+ HER2-negative breast cancer. This retrospective analysis of a prospectively designed registry evaluated treatments/outcomes in node-positive breast cancer patients who were Recurrence Score-tested through Clalit Health Services from 1/2006 through 12/2011 ( N = 709). Medical records were reviewed to verify treatments/recurrences/survival. Median follow-up, 5.9 years; median age, 62 years; 53.9% grade 2; 69.8% tumors ≤ 2 cm; 84.5% invasive ductal carcinoma; 42.0% N1mi, and 37.2%/15.5%/5.2% with 1/2/3 positive nodes; 53.4% Recurrence Score < 18, 36.4% Recurrence Score 18–30, and 10.2% Recurrence Score ≥ 31. Overall, 26.9% received adjuvant chemotherapy: 7.1%, 39.5%, and 86.1% in the Recurrence Score < 18, 18–30, and ≥ 31 group, respectively. The 5-year Kaplan–Meier estimates for distant recurrence were 3.2%, 6.3%, and 16.9% for these respective groups and the corresponding 5-year breast cancer death estimates were 0.5%, 3.4%, and 5.7%. In Recurrence Score < 18 patients, 5-year distant-recurrence rates for N1mi/1 positive node/2–3 positive nodes were 1.2%/4.4%/5.4%. As patients were not randomized to treatment and treatment decision is heavily influenced by Recurrence Score, analysis of 5-year distant recurrence by chemotherapy use was exploratory and should be interpreted cautiously: In Recurrence Score < 18, recurrence rate was 7.7% in chemotherapy-treated ( n = 27) and 2.9% in chemotherapy-untreated patients ( n = 352); P = 0.245. In Recurrence Score 18–30, recurrence rate in chemotherapy-treated patients ( n = 102) was significantly lower than in untreated patients ( n = 156) (1.0% vs. 9.7% P = 0.019); in Recurrence Score ≤ 25 (the RxPONDER study cutoff), recurrence rate was 2.3% in chemotherapy-treated ( n = 89) and 4.4% in chemotherapy-untreated patients ( n = 488); P = 0.521. In conclusion, our findings support using endocrine therapy alone in ER+ HER2-negative breast cancer patients with micrometastases/1–3 positive nodes and Recurrence Score < 18.