Ten-year distant-recurrence risk prediction in breast cancer by CanAssist Breast (CAB) in Dutch sub-cohort of the randomized TEAM trial.

Xi Zhang, Aparna Gunda, Elma Meershoek-Klein Kranenbarg, Gerrit-Jan Liefers, Badada Ananthamurthy Savitha, Payal Shrivastava, Chandra Prakash Vijay Kumar Serkad, Taranjot Kaur, Mallikarjuna Siraganahalli Eshwaraiah, Rob A E M Tollenaar, Cornelis J H van de Velde, Caroline M J Seynaeve, Manjiri Bakre, Peter J K Kuppen
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引用次数: 3

Abstract

Background: Hormone receptor (HR)-positive, HER2/neu-negative breast cancers have a sustained risk of recurrence up to 20 years from diagnosis. TEAM (Tamoxifen, Exemestane Adjuvant Multinational) is a large, multi-country, phase III trial that randomized 9776 women for the use of hormonal therapy. Of these 2754 were Dutch patients. The current study aims for the first time to correlate the ten-year clinical outcomes with predictions by CanAssist Breast (CAB)-a prognostic test developed in South East Asia, on a Dutch sub-cohort that participated in the TEAM. The total Dutch TEAM cohort and the current Dutch sub-cohort were almost similar with respect to patient age and tumor anatomical features.

Methods: Of the 2754 patients from the Netherlands, which are part of the original TEAM trial, 592 patients' samples were available with Leiden University Medical Center (LUMC). The risk stratification of CAB was correlated with outcomes of patients using logistic regression approaches entailing Kaplan-Meier survival curves, univariate and multivariate cox-regression hazards model. We used hazard ratios (HRs), the cumulative incidence of distant metastasis/death due to breast cancer (DM), and distant recurrence-free interval (DRFi) for assessment.

Results: Out of 433 patients finally included, the majority, 68.4% had lymph node-positive disease, while only a minority received chemotherapy (20.8%) in addition to endocrine therapy. CAB stratified 67.5% of the total cohort as low-risk [DM = 11.5% (95% CI, 7.6-15.2)] and 32.5% as high-risk [DM = 30.2% (95% CI, 21.9-37.6)] with an HR of 2.90 (95% CI, 1.75-4.80; P < 0.001) at ten years. CAB risk score was an independent prognostic factor in the consideration of clinical parameters in multivariate analysis. At ten years, CAB high-risk had the worst DRFi of 69.8%, CAB low-risk in the exemestane monotherapy arm had the best DRFi of 92.7% [vs CAB high-risk, HR, 0.21 (95% CI, 0.11-0.43), P < 0.001], and CAB low-risk in the sequential arm had a DRFi of 84.2% [vs CAB high-risk, HR, 0.48 (95% CI, 0.28-0.82), P = 0.009].

Conclusions: Cost-effective CAB is a statistically robust prognostic and predictive tool for ten-year DM for postmenopausal women with HR+/HER2-, early breast cancer. CAB low-risk patients who received exemestane monotherapy had an excellent ten-year DRFi.

Abstract Image

Abstract Image

Abstract Image

CanAssist breast (CAB)在荷兰随机TEAM试验亚队列中对乳腺癌10年远期复发风险的预测
背景:激素受体(HR)阳性,HER2/新阴性乳腺癌在诊断后20年内有持续的复发风险。TEAM(他莫昔芬,依西美坦辅助多国)是一项大型,多国,III期试验,随机9776名妇女使用激素治疗。其中2754名是荷兰患者。目前的研究旨在首次将10年的临床结果与CanAssist Breast (CAB)的预测联系起来。CAB是一种东南亚开发的预后测试,针对的是一个参加TEAM的荷兰亚队列。总的荷兰TEAM队列和目前的荷兰亚队列在患者年龄和肿瘤解剖特征方面几乎相似。方法:来自荷兰的2754例患者是TEAM原始试验的一部分,莱顿大学医学中心(LUMC)提供了592例患者样本。采用Kaplan-Meier生存曲线、单因素和多因素cox回归风险模型等logistic回归方法,将CAB的风险分层与患者的预后相关。我们使用风险比(hr)、乳腺癌远处转移/死亡的累积发生率(DM)和远处无复发间隔(DRFi)进行评估。结果:在最终纳入的433例患者中,大多数(68.4%)为淋巴结阳性疾病,而只有少数患者在内分泌治疗的基础上接受了化疗(20.8%)。CAB将67.5%的患者分层为低危组[DM = 11.5% (95% CI, 7.6-15.2)], 32.5%的患者分层为高危组[DM = 30.2% (95% CI, 21.9-37.6)],风险比为2.90 (95% CI, 1.75-4.80;结论:对于HR+/HER2-早期乳腺癌绝经后妇女,具有成本效益的CAB是一种统计上可靠的10年糖尿病预后和预测工具。接受依西美坦单药治疗的CAB低风险患者具有良好的10年DRFi。
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