Adjuvant treatment decision in patients with node-negative, ER+/Her2-, early stage breast cancer with Oncotype DX (ODX) recurrence score (RS) of 11-30: Impact of clinicopathologic features.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12022-e12022
Author(s):  
Gwenalyn Garcia ◽  
Shiksha Kedia ◽  
Nishitha Thumallapally ◽  
Elias Moussaly ◽  
Saqib Abbasi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Stage ◽  
Univariate Analysis ◽  
Prospective Trial ◽  
Recurrence Score ◽  
Clinicopathologic Features ◽  
Node Negative ◽  
Her2 Breast Cancer ◽  
Node Negative Breast Cancer

e12022 Background: The ODX RS predicts the risk of distant recurrence and the benefit of adjuvant chemotherapy (CT) in patients with ER+/Her2- breast cancer. High RS predicts a large benefit whereas low RS predicts minimal benefit from CT. A prospective trial showed that patients with low RS of 0-10 may be safely spared adjuvant CT. Recommendations in patients with intermediate RS are less clear. We performed a retrospective study of adjuvant therapy decision in patients with RS 11-30. Methods: We identified patients with ER+/Her2-, node-negative breast cancer with ODX RS 11-30 treated at our center from 2010-2016. Data on patient age, type of surgery, tumor size, grade, lymphovascular invasion (LVI), RS and treatment were collected. Statistical associations were tested using Chi square/Fisher's exact test and t test. Logistic regression analysis was used to determine odds ratios (OR). Results: 76 patients were identified. 86% (65/76) of them received adjuvant endocrine therapy alone and 14% (11/76) received adjuvant CT plus endocrine therapy. Patient characteristics are shown in the table. Using univariate analysis, significant predictors of receiving CT included RS, LVI, and ER positivity. In the patients who received CT, RSs were all ≥ 18 whereas in the group who did not receive CT, 42% (27/65) patients had RS 11-17. Increase in RS was associated with increase in the likelihood of receiving CT (OR 1.40, 95% CI 1.14-1.74, p=0.00017). Decrease in ER positivity was correlated with increased likelihood of receiving CT (OR 0.922, 95% CI 0.856-0.992, p=0.03). The presence of LVI increased the likelihood of receiving CT (OR 26.24, 95% CI 4.16-165.43, p=0.0005). Conclusions: In patients with ER+/Her2-, node-negative breast cancer with RS 11-30, the majority received endocrine therapy alone. RS and some clinicopathologic features (LVI, ER) impacted the decision to receive CT. [Table: see text]

Long-term outcomes and predictors of recurrence in patients with early-stage node negative breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12597-e12597
Author(s):  
Izzet Dogan ◽  
Esra Aydin ◽  
Nail Paksoy ◽  
Ferhat Ferhatoglu ◽  
Naziye Ak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Roc Analysis ◽  
Early Stage ◽  
Univariate Analysis ◽  
Nuclear Pleomorphism ◽  
Node Negative ◽  
Predictors Of Recurrence ◽  
Node Negative Breast Cancer ◽  
Number Of Patients

e12597 Background: In this study, we aimed to assess the outcomes, and predictors of recurrence in patients with early-stage node-negative breast cancer. Methods: We evaluated data of the patients who were treated between 1988 and 2018 years retrospectively. Demographical, clinical, pathological, and treatment features of the patients were recorded. SPSS 25 version was used for statistical analysis. We used Kaplan-Meier and Cox regression analysis to assess survival analysis. Also, we performed logistic regression and ROC analysis for recurrence predictors. Results: In total, 347 patients were included in the study.The median age was 50 (range, 18-81) at diagnosis. The percent of the patients who had stage 1 and 2 were 86.6% and 13.4%, respectively. The most common histopathological type was invasive ductal carcinoma (71.6%). Estrogen receptor and progesterone receptor positivity were 80.3% and 62.1%, respectively. Her2 receptor positivity was 15.9%. The number of patients who had undergone lumpectomy and mastectomy was 85.5% and 14.5%, respectively. Sentinel lymph node biopsy was performed on 78.7% of the patients, and axillary lymph node dissection 21.3%. Also, the patients received adjuvant radiotherapy (88.7%), adjuvant chemotherapy (48.5%), and adjuvant hormonotherapy (82.1%). Tumor recurrence was occurred in 31 (8.7%) patients (local recurrence-45.2% and metastasis-54.8%). Five-, ten- and twenty-years recurrence ratios were 4.3%, 8%, and 23%. Also, contralateral breast cancer has occurred in 19 (5.3%) patients. During the study period, 30 (8.4%) patients died. Ten-years and twenty-years survival ratios were 91.6% and 76.6%, respectively. In univariate analysis, aged over 65 years (p = 0.004), nuclear pleomorphism (p = 0.049), mitosis (p = 0.003), and necrosis (p = 0.002) were statistically significant for recurrence. In ROC analysis, the tumor's longest size was not statistically significant for recurrence (for over 1.45 cm, p = 0.07). Conclusions: In this study, we determined thirty-years outcomes in patients with early-stage node-negative breast cancer. In the follow-up, we detected the recurrences ratios, between ten and twenty years, were more common than the first ten-years. Despite a small number of patients who had a recurrence, we showed that being age over 65 years and pathological features (nuclear pleomorphism, mitosis, and necrosis) were statistically significant for disease recurrence in univariate analysis.

Role of 21- gene recurrence score in patients age ≥70 with T1N0 ER/PR+ HER2- breast cancer treated with breast-conserving surgery and endocrine therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 571-571
Author(s):  
Neil Chandrabhan Chevli ◽  
Waqar Haque ◽  
Kevin Thomas Tran ◽  
Andrew M. Farach ◽  
Mary R. Schwartz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Recurrence Score ◽  
Breast Conserving Surgery ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer ◽  
Kaplan Meier ◽  
Node Negative Breast Cancer ◽  
Cox Proportional Hazard Models

571 Background: Based on the results of the CALGB 9343 trial, patients age ≥70 with T1N0 ER/PR+ HER2- breast cancer who are treated with breast conserving surgery (BCS) and endocrine therapy (ET) are candidates for omission of radiotherapy (RT). This trial predated the 21- gene RT-PCR recurrence score (RS) test, which is an assay now available for patients with hormone receptor positive, HER2 negative, node negative breast cancer to determine who will benefit from chemotherapy. Whether the RS can predict for patients most likely to benefit from radiation therapy (RT) following BCS has not been previously examined. The purpose of this study was to use a large database of patients age ≥70 with T1N0 ER/PR+ HER2- disease to determine if RS could predict who would benefit from RT following BCS. Methods: The National Cancer Database (NCDB) was queried (2004-2017) for female patients age ≥70 with pT1N0 ER+ PR+ HER2- breast cancer treated with BCS and ET and who had an available RS. Patients were stratified based on their RS (low risk [LR] = 1-10, intermediate risk [IR] = 11-25, high risk [HR] = 26-99). For survival analysis, propensity score matching (PSM) was conducted overall and for each group to create 1:1 matched cohorts of patients who received radiotherapy and patients who did not. Kaplan-Meier analysis with log-rank testing was used to evaluate overall survival (OS). Univariable (UVA) and multivariable (MVA) analysis were conducted using Cox proportional hazard models to determine which clinical and treatment factors were prognostic for OS. Results: A total of 13,614 patients met the selection criteria: 3,840 in the LR cohort, 8,383 in the IR cohort, and 1,391 in the HR cohort. A total of 79% received RT: 77% in the LR cohort, 79% in the IR cohort, and 85% in the HR cohort. Because PSM could not be efficiently performed in the HR cohort alone, the IR and HR cohort were merged (IRHR) for matching. After PSM, overall the 5-year OS was 90% for those who received RT and 88% for those who did not (p = 0.03). The 5-year OS in the LR cohort was 89% for those who received RT and 89% for those who did not (p = 0.517). In the IRHR cohort, the 5-year OS was 93% for those who received RT and 88% for those who did not (p = 0.004). On MVA in the overall cohort, RT (p = 0.037) was predictive of improved OS while increasing age (p < 0.001) and CDCC comorbidity score (p < 0.001) were predictive of worse OS. On MVA in the LR cohort, RT (p = 0.602) was not predictive of improved OS. However, on MVA in the IRHR cohort, RT (p = 0.004) was a positive prognostic factor for OS. Conclusions: This is the first study investigating the role of RS in this subset of patients eligible for omission of radiotherapy. There is an OS benefit with the use of RT in patients with IRHR RS, but not in patients with LR RS. Pending prospective evaluation, assessment of RS in this older subset of patients is recommended with consideration of RT when RS is ≥11.

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