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Recurrence Score Testing Does not Appear to Benefit Patients With Grade 1, Progesterone Receptor-Positive Breast
Udai S Sibia1, Thomas J Sanders1, Charles Mylander1
1The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA.
Hematology/Oncology and Stem Cell Therapy
|June 26, 2021
Summary
The Anne Arundel Medical Center (AAMC) model may help omit recurrence score (RS) testing in early-stage breast cancer. Chemotherapy did not improve survival in discordant risk groups, supporting omission of RS testing for Grade 1, PR+ tumors.
Area of Science:
- Oncology
- Breast Cancer Research
- Clinical Decision Support
Background:
- A previously developed Anne Arundel Medical Center (AAMC) risk prediction model based on pathology may reduce the need for recurrence score (RS) testing in early-stage breast cancer.
- Concerns exist regarding overtreatment or undertreatment in patients with discordant risk predictions between the AAMC model and RS testing.
Purpose of the Study:
- To evaluate the impact of adjuvant chemotherapy on survival outcomes in early-stage breast cancer patients with discordant risk predictions between the AAMC model and RS testing.
- To determine if omitting RS testing is appropriate for specific patient subgroups based on pathological features.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) for breast cancer patient data.
- Defined AAMC low-risk as Grade 1 and progesterone receptor-positive (PR+) tumors; AAMC high-risk as Grade 3 or estrogen-negative tumors.
- Defined RS low-risk and high-risk groups based on RS values and patient age.
Main Results:
- Analyzed 71,212 cases, identifying 590 AAMC low-risk/RS high-risk and 5,596 AAMC high-risk/RS low-risk discordant cases.
- In AAMC low-risk/RS high-risk discordant cases, 10-year breast cancer-specific survival (BCSS) and overall survival (OS) did not differ significantly between chemotherapy and no-chemotherapy groups.
- In AAMC high-risk/RS low-risk discordant cases, 10-year BCSS and OS also showed no significant difference between chemotherapy and no-chemotherapy groups.
Conclusions:
- Adjuvant chemotherapy did not improve survival in either the AAMC low-risk/RS high-risk or AAMC high-risk/RS low-risk discordant groups.
- These findings support considering the omission of RS testing for patients with Grade 1, PR+ tumors.
- Patients with Grade 3 tumors appear to benefit from RS testing, warranting its continued use in this subgroup.
