Utility of Oncotype DX score in clinical management for T1 estrogen receptor positive, HER2 negative, and lymph node negative breast cancer
Background The management of estrogen receptor positive (ER+)/HER2− and lymph node (LN) negative breast cancers can be influenced by Oncotype DX recurrence score (RS) in the USA. However, the benefit of RS in T1 tumors (≤ 1 cm) is not clear. Methods We retrieved 199 T1 ER+/HER2−/LN− breast cancer di...
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| Veröffentlicht in: | Breast cancer research and treatment 2022-04, Vol.192 (3), p.509-516 |
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| creator | Nguyen, Thi Truc Anh Postlewait, Lauren M. Zhang, Chao Meisel, Jane L. O’Regan, Ruth Badve, Sunil Kalinsky, Kevin Li, Xiaoxian |
| description | Background
The management of estrogen receptor positive (ER+)/HER2− and lymph node (LN) negative breast cancers can be influenced by Oncotype DX recurrence score (RS) in the USA. However, the benefit of RS in T1 tumors (≤ 1 cm) is not clear.
Methods
We retrieved 199 T1 ER+/HER2−/LN− breast cancer diagnosed between 1993 and 2016 that had undergone RS testing. The median follow-up time was 51 months. We examined the disease-free survival (DFS) and distant metastasis and their association with RS and other clinicopathologic features.
Results
Of the 199 cases, 40 were T1a (≤ 0.5 cm) and 159 were T1b (> 0.5 cm to 1 cm) tumors. In the 40 T1a tumors, 11 would benefit from chemotherapy by the TAILORx study results. Of these T1a tumors, 36 were Nottingham grade 1/2, 3 were grade 3, and 1 was microinvasive carcinoma; 2 (5%) had local recurrence and 1 (2.5%) had distant metastasis to the bone. The only patient with T1a tumor (Nottingham grade 3, RS = 42) and distant metastasis to bone had received adjuvant chemotherapy. In the 159 T1b tumors, 25 would benefit chemotherapy by the TAILORx results. Of the T1b tumors, 149 were Nottingham grade 1/2 and 10 were grade 3. Nine (5.7%) had local recurrence and 2 (1.3%) had distant metastasis to bone and mediastinum, respectively. The two T1b tumors with distant metastasis had a RS 20 and Nottingham grade 2, and RS 27 and Nottingham grade 3, respectively. Both patients received adjuvant chemotherapy. In multivariate analysis of the entire cohort (T1a and T1b tumors), Nottingham tumor grade and receiving chemotherapy were significantly associated with DFS. In univariate analysis of the entire cohort, Nottingham tumor grade, receiving adjuvant chemotherapy, and RS were significantly associated with distant metastasis.
Conclusion
This study demonstrates that the metastatic rate of T1a and T1b ER+/HER2−/LN− breast cancer is very low. Patients with low grade (1 or 2), T1a ER+/HER2−/LN− breast cancer may not need RS for treatment decision-making; however, in patients with high-grade T1a or T1b ER+/HER2−/LN− breast cancer, RS analysis should be strongly considered. |
| doi_str_mv | 10.1007/s10549-022-06530-6 |
| format | Article |
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The management of estrogen receptor positive (ER+)/HER2− and lymph node (LN) negative breast cancers can be influenced by Oncotype DX recurrence score (RS) in the USA. However, the benefit of RS in T1 tumors (≤ 1 cm) is not clear.
Methods
We retrieved 199 T1 ER+/HER2−/LN− breast cancer diagnosed between 1993 and 2016 that had undergone RS testing. The median follow-up time was 51 months. We examined the disease-free survival (DFS) and distant metastasis and their association with RS and other clinicopathologic features.
Results
Of the 199 cases, 40 were T1a (≤ 0.5 cm) and 159 were T1b (> 0.5 cm to 1 cm) tumors. In the 40 T1a tumors, 11 would benefit from chemotherapy by the TAILORx study results. Of these T1a tumors, 36 were Nottingham grade 1/2, 3 were grade 3, and 1 was microinvasive carcinoma; 2 (5%) had local recurrence and 1 (2.5%) had distant metastasis to the bone. The only patient with T1a tumor (Nottingham grade 3, RS = 42) and distant metastasis to bone had received adjuvant chemotherapy. In the 159 T1b tumors, 25 would benefit chemotherapy by the TAILORx results. Of the T1b tumors, 149 were Nottingham grade 1/2 and 10 were grade 3. Nine (5.7%) had local recurrence and 2 (1.3%) had distant metastasis to bone and mediastinum, respectively. The two T1b tumors with distant metastasis had a RS 20 and Nottingham grade 2, and RS 27 and Nottingham grade 3, respectively. Both patients received adjuvant chemotherapy. In multivariate analysis of the entire cohort (T1a and T1b tumors), Nottingham tumor grade and receiving chemotherapy were significantly associated with DFS. In univariate analysis of the entire cohort, Nottingham tumor grade, receiving adjuvant chemotherapy, and RS were significantly associated with distant metastasis.
Conclusion
This study demonstrates that the metastatic rate of T1a and T1b ER+/HER2−/LN− breast cancer is very low. Patients with low grade (1 or 2), T1a ER+/HER2−/LN− breast cancer may not need RS for treatment decision-making; however, in patients with high-grade T1a or T1b ER+/HER2−/LN− breast cancer, RS analysis should be strongly considered.</description><identifier>ISSN: 0167-6806</identifier><identifier>EISSN: 1573-7217</identifier><identifier>DOI: 10.1007/s10549-022-06530-6</identifier><identifier>PMID: 35084624</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biomarkers, Tumor - genetics ; Bone tumors ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - genetics ; Cancer ; Cancer research ; Chemotherapy ; Chemotherapy, Adjuvant ; Decision making ; Diagnosis ; ErbB-2 protein ; Estrogen ; Estrogen receptors ; Estrogens ; Female ; Humans ; Lymph nodes ; Lymphatic system ; Mediastinum ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Multivariate analysis ; Neoplasm Recurrence, Local - drug therapy ; Oncology ; Patients ; Phenols ; Preclinical Study ; Prognosis ; Receptor, ErbB-2 - genetics ; Receptors, Estrogen - genetics ; Tumors</subject><ispartof>Breast cancer research and treatment, 2022-04, Vol.192 (3), p.509-516</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>COPYRIGHT 2022 Springer</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c473t-755c2ac1e8bf8a518aad1964c4e9c35179f53de800ba7b01e74d462e3dbc80c13</citedby><cites>FETCH-LOGICAL-c473t-755c2ac1e8bf8a518aad1964c4e9c35179f53de800ba7b01e74d462e3dbc80c13</cites><orcidid>0000-0002-0995-1721</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10549-022-06530-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10549-022-06530-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35084624$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyen, Thi Truc Anh</creatorcontrib><creatorcontrib>Postlewait, Lauren M.</creatorcontrib><creatorcontrib>Zhang, Chao</creatorcontrib><creatorcontrib>Meisel, Jane L.</creatorcontrib><creatorcontrib>O’Regan, Ruth</creatorcontrib><creatorcontrib>Badve, Sunil</creatorcontrib><creatorcontrib>Kalinsky, Kevin</creatorcontrib><creatorcontrib>Li, Xiaoxian</creatorcontrib><title>Utility of Oncotype DX score in clinical management for T1 estrogen receptor positive, HER2 negative, and lymph node negative breast cancer</title><title>Breast cancer research and treatment</title><addtitle>Breast Cancer Res Treat</addtitle><addtitle>Breast Cancer Res Treat</addtitle><description>Background
The management of estrogen receptor positive (ER+)/HER2− and lymph node (LN) negative breast cancers can be influenced by Oncotype DX recurrence score (RS) in the USA. However, the benefit of RS in T1 tumors (≤ 1 cm) is not clear.
Methods
We retrieved 199 T1 ER+/HER2−/LN− breast cancer diagnosed between 1993 and 2016 that had undergone RS testing. The median follow-up time was 51 months. We examined the disease-free survival (DFS) and distant metastasis and their association with RS and other clinicopathologic features.
Results
Of the 199 cases, 40 were T1a (≤ 0.5 cm) and 159 were T1b (> 0.5 cm to 1 cm) tumors. In the 40 T1a tumors, 11 would benefit from chemotherapy by the TAILORx study results. Of these T1a tumors, 36 were Nottingham grade 1/2, 3 were grade 3, and 1 was microinvasive carcinoma; 2 (5%) had local recurrence and 1 (2.5%) had distant metastasis to the bone. The only patient with T1a tumor (Nottingham grade 3, RS = 42) and distant metastasis to bone had received adjuvant chemotherapy. In the 159 T1b tumors, 25 would benefit chemotherapy by the TAILORx results. Of the T1b tumors, 149 were Nottingham grade 1/2 and 10 were grade 3. Nine (5.7%) had local recurrence and 2 (1.3%) had distant metastasis to bone and mediastinum, respectively. The two T1b tumors with distant metastasis had a RS 20 and Nottingham grade 2, and RS 27 and Nottingham grade 3, respectively. Both patients received adjuvant chemotherapy. In multivariate analysis of the entire cohort (T1a and T1b tumors), Nottingham tumor grade and receiving chemotherapy were significantly associated with DFS. In univariate analysis of the entire cohort, Nottingham tumor grade, receiving adjuvant chemotherapy, and RS were significantly associated with distant metastasis.
Conclusion
This study demonstrates that the metastatic rate of T1a and T1b ER+/HER2−/LN− breast cancer is very low. Patients with low grade (1 or 2), T1a ER+/HER2−/LN− breast cancer may not need RS for treatment decision-making; however, in patients with high-grade T1a or T1b ER+/HER2−/LN− breast cancer, RS analysis should be strongly considered.</description><subject>Biomarkers, Tumor - genetics</subject><subject>Bone tumors</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - genetics</subject><subject>Cancer</subject><subject>Cancer research</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Decision making</subject><subject>Diagnosis</subject><subject>ErbB-2 protein</subject><subject>Estrogen</subject><subject>Estrogen receptors</subject><subject>Estrogens</subject><subject>Female</subject><subject>Humans</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Mediastinum</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Multivariate analysis</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Oncology</subject><subject>Patients</subject><subject>Phenols</subject><subject>Preclinical Study</subject><subject>Prognosis</subject><subject>Receptor, ErbB-2 - genetics</subject><subject>Receptors, Estrogen - genetics</subject><subject>Tumors</subject><issn>0167-6806</issn><issn>1573-7217</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kt9qFTEQxhdR7LH6Al5IQBAv3Dr5s8nuZanVCoWCtOBdyGZnz0nZTdYkRzjP4EubemprRSQXITO_b5iPfFX1ksIRBVDvE4VGdDUwVoNsONTyUbWijeK1YlQ9rlZApaplC_KgepbSNQB0Crqn1QFvoBWSiVX14yq7yeUdCSO58Dbk3YLkw1eSbIhInCd2ct5ZM5HZeLPGGX0mY4jkkhJMOYY1ehLR4pJLcQnJZfcd35Gz0y-MeFyb_dP4gUy7edkQHwa8a5A-okmZWOMtxufVk9FMCV_c3ofV1cfTy5Oz-vzi0-eT4_PaCsVzrZrGMmMptv3Ymoa2xgy0k8IK7CxvqOrGhg_YAvRG9UBRiaGYRT70tgVL-WH1dj93ieHbtrjQs0sWp8l4DNukmWScs1ZCW9DXf6HXYRt92a5QQjAGgtF7am0m1M6PIUdjb4bqY9m15W8aKgp19A-qnAFnZ4PH0ZX6A8GbPwQbNFPepDBtsws-PQTZHrQxpBRx1Et0s4k7TUHfREXvo6JLVPSvqGhZRK9urW37GYc7ye9sFIDvgVRafo3x3vt_xv4EPdXHYQ</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Nguyen, Thi Truc Anh</creator><creator>Postlewait, Lauren M.</creator><creator>Zhang, Chao</creator><creator>Meisel, Jane L.</creator><creator>O’Regan, Ruth</creator><creator>Badve, Sunil</creator><creator>Kalinsky, Kevin</creator><creator>Li, Xiaoxian</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0995-1721</orcidid></search><sort><creationdate>20220401</creationdate><title>Utility of Oncotype DX score in clinical management for T1 estrogen receptor positive, HER2 negative, and lymph node negative breast cancer</title><author>Nguyen, Thi Truc Anh ; Postlewait, Lauren M. ; Zhang, Chao ; Meisel, Jane L. ; O’Regan, Ruth ; Badve, Sunil ; Kalinsky, Kevin ; Li, Xiaoxian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c473t-755c2ac1e8bf8a518aad1964c4e9c35179f53de800ba7b01e74d462e3dbc80c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Biomarkers, Tumor - genetics</topic><topic>Bone tumors</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - genetics</topic><topic>Cancer</topic><topic>Cancer research</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>Decision making</topic><topic>Diagnosis</topic><topic>ErbB-2 protein</topic><topic>Estrogen</topic><topic>Estrogen receptors</topic><topic>Estrogens</topic><topic>Female</topic><topic>Humans</topic><topic>Lymph nodes</topic><topic>Lymphatic system</topic><topic>Mediastinum</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Multivariate analysis</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Oncology</topic><topic>Patients</topic><topic>Phenols</topic><topic>Preclinical Study</topic><topic>Prognosis</topic><topic>Receptor, ErbB-2 - genetics</topic><topic>Receptors, Estrogen - genetics</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyen, Thi Truc Anh</creatorcontrib><creatorcontrib>Postlewait, Lauren M.</creatorcontrib><creatorcontrib>Zhang, Chao</creatorcontrib><creatorcontrib>Meisel, Jane L.</creatorcontrib><creatorcontrib>O’Regan, Ruth</creatorcontrib><creatorcontrib>Badve, Sunil</creatorcontrib><creatorcontrib>Kalinsky, Kevin</creatorcontrib><creatorcontrib>Li, Xiaoxian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Breast cancer research and treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyen, Thi Truc Anh</au><au>Postlewait, Lauren M.</au><au>Zhang, Chao</au><au>Meisel, Jane L.</au><au>O’Regan, Ruth</au><au>Badve, Sunil</au><au>Kalinsky, Kevin</au><au>Li, Xiaoxian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utility of Oncotype DX score in clinical management for T1 estrogen receptor positive, HER2 negative, and lymph node negative breast cancer</atitle><jtitle>Breast cancer research and treatment</jtitle><stitle>Breast Cancer Res Treat</stitle><addtitle>Breast Cancer Res Treat</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>192</volume><issue>3</issue><spage>509</spage><epage>516</epage><pages>509-516</pages><issn>0167-6806</issn><eissn>1573-7217</eissn><abstract>Background
The management of estrogen receptor positive (ER+)/HER2− and lymph node (LN) negative breast cancers can be influenced by Oncotype DX recurrence score (RS) in the USA. However, the benefit of RS in T1 tumors (≤ 1 cm) is not clear.
Methods
We retrieved 199 T1 ER+/HER2−/LN− breast cancer diagnosed between 1993 and 2016 that had undergone RS testing. The median follow-up time was 51 months. We examined the disease-free survival (DFS) and distant metastasis and their association with RS and other clinicopathologic features.
Results
Of the 199 cases, 40 were T1a (≤ 0.5 cm) and 159 were T1b (> 0.5 cm to 1 cm) tumors. In the 40 T1a tumors, 11 would benefit from chemotherapy by the TAILORx study results. Of these T1a tumors, 36 were Nottingham grade 1/2, 3 were grade 3, and 1 was microinvasive carcinoma; 2 (5%) had local recurrence and 1 (2.5%) had distant metastasis to the bone. The only patient with T1a tumor (Nottingham grade 3, RS = 42) and distant metastasis to bone had received adjuvant chemotherapy. In the 159 T1b tumors, 25 would benefit chemotherapy by the TAILORx results. Of the T1b tumors, 149 were Nottingham grade 1/2 and 10 were grade 3. Nine (5.7%) had local recurrence and 2 (1.3%) had distant metastasis to bone and mediastinum, respectively. The two T1b tumors with distant metastasis had a RS 20 and Nottingham grade 2, and RS 27 and Nottingham grade 3, respectively. Both patients received adjuvant chemotherapy. In multivariate analysis of the entire cohort (T1a and T1b tumors), Nottingham tumor grade and receiving chemotherapy were significantly associated with DFS. In univariate analysis of the entire cohort, Nottingham tumor grade, receiving adjuvant chemotherapy, and RS were significantly associated with distant metastasis.
Conclusion
This study demonstrates that the metastatic rate of T1a and T1b ER+/HER2−/LN− breast cancer is very low. Patients with low grade (1 or 2), T1a ER+/HER2−/LN− breast cancer may not need RS for treatment decision-making; however, in patients with high-grade T1a or T1b ER+/HER2−/LN− breast cancer, RS analysis should be strongly considered.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35084624</pmid><doi>10.1007/s10549-022-06530-6</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0995-1721</orcidid></addata></record> |
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| ispartof | Breast cancer research and treatment, 2022-04, Vol.192 (3), p.509-516 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Biomarkers, Tumor - genetics Bone tumors Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - genetics Cancer Cancer research Chemotherapy Chemotherapy, Adjuvant Decision making Diagnosis ErbB-2 protein Estrogen Estrogen receptors Estrogens Female Humans Lymph nodes Lymphatic system Mediastinum Medicine Medicine & Public Health Metastases Metastasis Multivariate analysis Neoplasm Recurrence, Local - drug therapy Oncology Patients Phenols Preclinical Study Prognosis Receptor, ErbB-2 - genetics Receptors, Estrogen - genetics Tumors |
| title | Utility of Oncotype DX score in clinical management for T1 estrogen receptor positive, HER2 negative, and lymph node negative breast cancer |
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