晚期乳腺癌复发和生存的临床和基因组风险
Joseph A Sparano1, Michael Crager2, Robert J Gray3
1Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York.
NEJM evidence
|July 23, 2024
概括
21基因复发分数 (RS) 试验在与临床病理因素相结合时,改善了早期乳腺癌中远程复发风险预测. 这种综合模型提供了比RS或单独的晚期复发因素更好的预后信息.
科学领域:
- 在瘤学瘤学.
- 基因组学就是基因组学.
- 生物统计学 生物统计学
背景情况:
- 21基因复发分数 (RS) 试验 (瘤型DX) 对于指导早期,激素受体阳性,HER2-阴性乳腺癌的辅助化疗至关重要.
- 在已确定的临床病理因素之外,RS对晚期远程复发的预后价值仍在调查中.
研究的目的:
- 评估21基因RS对临床病理学因素的预后价值,以预测早期乳腺癌的远期复发.
- 开发和验证一个综合预后模型 (RSClin) 以改善风险分层.
主要方法:
- 从三项试验中对10,004名患者的元分析被更新为扩展后续数据.
- 该RS与组织学等级,瘤大小和年龄相结合,创建了RSClin工具.
- 外部验证是在1098名患者的独立队列中进行的.
主要成果:
- 与单独临床病理因素 (ΔLR χ2,86.2;P<0.001) 和单独RS (ΔLR χ2,131.0;P<0.001) 相比,RSlin模型显著改善了预后信息.
- 该模型在一个独立的队列中证明了在诊断后长达10年的远程复发的预后能力.
- RSClin准确地近似观察到10年 (林一致性,0.87) 和5-10年 (林一致性,0.92) 之间的远程复发风险.
结论:
- 21-基因RS是早期乳腺癌中远期复发和存活的显著预后标志物.
- 将21基因RS与临床病理因素相结合,可以提高远程复发风险估计,并有效地分层晚期复发风险.
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