The clinical usefulness of the CTS5 in the prediction of late distant recurrence in postmenopausal women with estrogen receptor-positive early breast cancer

Abstract

Background Clinical Treatment Score post-5 years (CTS5) is a promising prognostic tool to evaluate late distant recurrence (DR) risk for breast cancer after 5-year adjuvant endocrine therapy. Patients and methods Among 560 postmenopausal women with pathological stage I–III estrogen receptor-positive (ER+) primary breast cancer, 383 women who had received 5-year adjuvant endocrine therapy without any recurrence at 5 years after surgery were included in this study. The CTS5 was calculated for each patient using a previously published formula, and the patients were stratified by their CTS5 values into the low-, intermediate- and high-CTS5 risk groups. Results According to the CTS5, 205 (53.5%), 106 (27.7%) and 72 (18.8%) patients were classified into the low-, intermediate-, and high-CTS5 risk groups, respectively. A higher ER expression level was significantly associated with the low CTS5. The increased administration of adjuvant chemotherapy was significantly associated with a high CTS5. The occurrence of DR was higher in the intermediate and high CTS5 groups than in the low CTS5 group. The DRFS in the low CTS5 risk group was significantly better than that in the intermediate- or high-risk groups. In the ER-high or HER2-negative (HER2−) group, the DRFS in the low-risk group was significantly better than that of the intermediate- or high-risk groups. However, in the low-ER or HER2-positive group, there was no significant difference in DRFS among the three risk groups. Conclusions In postmenopausal women with ER+ breast cancer, low CTS5 was considered to be associated with a very low risk of late DR. Thus, extended endocrine therapy may be unnecessary for patients with low CTS5 scores. Extended endocrine therapy should be offered for patients with intermediate or high CTS5 scores, especially those with high-ER and HER2− breast cancer.

Prevalence, treatment patterns, and prognosis of low estrogen receptor-positive (1% to 10%) breast cancer: a single institution’s experience in Korea

“…Only 117 patients, 2% of the total and 2.4% of ER+ tumors, had ER-Low tumors as determined by APS. This is consistent with other studies [17][18][19][20][21][22] and a meta-analysis [15] that found a similarly low percentage of patients with ER-Low tumors. In the largest published individual study (N=9639), Yi et al found that 250 patients (2.6%) had ER-Low tumors [10], and in the meta-analysis, a rate of 5% (834/16,606) was reported [15].…”

Extended Adjuvant Endocrine Treatment in Luminal Breast Cancers in the Era of Genomic Tests

“…Tajiri et al [ 30 ] investigated the clinical usefulness of CTS5 in a study of 560 postmenopausal patients with ER+ BC. After 5 years of adjuvant ET, patients were divided into three risk categories based on CTS5.…”

The Utility of Breast Cancer Index (BCI) Over Clinical Prognostic Tools for Predicting the Need for Extended Endocrine Therapy: A Safety Net Hospital Experience

“…Further study indicated that CTS5 had a good discriminating power for long-term recurrence risk of HER2-patients, irrespective of menopausal status. 16 However, for HER2 + postmenopausal patients, the model had less effective prognostic value and it was suggested that further large-scale studies are warranted to assess its prognostic value in HER 2 + BC. 16 CTS5 is calculated using the following formula: CTS5 = 0.438 × nodes + 0.988 × (0.093 × size − 0.001 × size 2 + 0.375 × grade + 0.017 × age).…”

“…16 However, for HER2 + postmenopausal patients, the model had less effective prognostic value and it was suggested that further large-scale studies are warranted to assess its prognostic value in HER 2 + BC. 16 CTS5 is calculated using the following formula: CTS5 = 0.438 × nodes + 0.988 × (0.093 × size − 0.001 × size 2 + 0.375 × grade + 0.017 × age). 16 Results of this score are reported as low risk ( < 5%), medium risk (5% to 10%), and high risk ( > 10%) of late distant recurrence, and these risk categories are used to identify patients who may benefit from EET.…”

“…16 CTS5 is calculated using the following formula: CTS5 = 0.438 × nodes + 0.988 × (0.093 × size − 0.001 × size 2 + 0.375 × grade + 0.017 × age). 16 Results of this score are reported as low risk ( < 5%), medium risk (5% to 10%), and high risk ( > 10%) of late distant recurrence, and these risk categories are used to identify patients who may benefit from EET. 15 Breast Cancer Index (BCI) is a validated bio-marker test that incorporates 2 distinct genomic assays to estimate late relapse risk and likelihood of benefit from EET in patients with HR positive breast cancer.…”