The 21-Gene Recurrence Score and Locoregional Recurrence in Breast Cancer Patients

Abstract

Purpose Although the 21-gene recurrence score (RS) assay has been validated to assess the risk of distant recurrence in hormone receptor-positive breast cancer patients, the relationship between RS and the risk of locoregional recurrence (LRR) remains unclear. The purpose of this study was to determine if RS is associated with LRR in breast cancer patients and whether this relationship varies based on the type of local treatment [mastectomy or breast-conserving therapy (BCT)]. Methods 163 consecutive estrogen receptor-positive breast cancer patients at our institution had an RS generated from the primary breast tumor between August 2006 and October 2009. Patients were treated with lumpectomy and radiation (BCT) (n = 110) or mastectomy alone (n = 53). Patients were stratified using a pre-determined RS of 25 and then grouped according to local therapy type. Results Median follow-up was 68.2 months. Patients who developed an LRR had stage I or IIA disease, >2 mm surgical margins, and received chemotherapy as directed by RS. While an RS > 25 did not predict for a higher rate of LRR, an RS > 24 was associated with LRR in our subjects. Among mastectomy patients, the 5-year LRR rate was 27.3 % in patients with an RS > 24 versus 10.7 % (p = 0.04) in those whose RS was ≤24. RS was not associated with LRR in patients who received BCT. Conclusions Breast cancer patients treated with mastectomy for tumors that have an RS > 24 are at high risk of LRR and may benefit from post-mastectomy radiation.

21-Gene recurrence score and locoregional recurrence in lymph node-negative, estrogen receptor-positive breast cancer

“…Mamounas et al first reported this association in 895 tamoxifen treated patients from the NSABP B-14 and B-20 trials (p<0.001), 424 chemotherapy and tamoxifen treated patients from the B-20 trial (p=0.028), and 355 placebo patients from the B-14 trial (p=0.022)[28]. LRR was associated with RS>24 in patients treated with total mastectomy in another smaller study[29]. In contrast, a retrospective analysis of 388 patients treated with breast conservation, radiation and adjuvant systemic chemotherapy in the ECOG E2197 trial showed no association between LRR and RS.…”

“…The association between the RS and LRR was first suggested in large patient cohorts from National Surgical Adjuvant Breast and Bowel Project (NSABP) trials B-14 and B-20[28]. However, subsequent smaller studies, including retrospective analysis of a subset of patients in the E2197 prospective randomized trial by the Eastern Cooperative Oncology Group (ECOG), did not confirm this finding[29–31]. …”

Computer-aided prognosis on breast cancer with hematoxylin and eosin histopathology images: A review

“…21 Over the past decade, molecular taxonomy has revealed molecular heterogeneity of BC and has been shown to provide more accurate prognostic information. [22][23][24] But the actual role of molecular techniques in clinical practice is limited by their availability. 20 Thus, BC management relies largely on inexpensive and routine morphological assessment of H&E images coupled with biomarker semi-quantification of IHC images.…”

The Era of Multigene Panels Comes? The Clinical Utility of Oncotype DX and MammaPrint

“…Due to the multigene panel including genes related to biological behavior such as cancer metastasis and invasion, the clinical utility of multigene panels will be expanded as studies continue. Jegadeesh et al found RS > 24 was related with LRR in patients who received mastectomy and that the 5-year LRR rate was 27.3% versus 10.7% in patients of RS ≤ 24, indicating patients with RS > 24 may benefit from post-mastectomy [ 33 ]. The recently published report from the NSABP B-28 also showed that RS was a strong predictive factor of LRR in ER-positive, node-positive breast cancer after treatment; the final result will reveal how RS helps in selecting patients for comprehensive radiology, which may broaden the clinical utility of RS [ 34 ].…”