21-gene recurrence score assay predicts benefit of post-mastectomy radiotherapy in T1-2 N1 breast cancer

Chelain R. Goodman*, Brandon Luke L. Seagle, Masha Kocherginsky, Eric Donald Donnelly, Shohreh Shahabi, Jonathan B Strauss

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Post-mastectomy radiotherapy (PMRT) yields improvements in both locoregional control and overall survival (OS) for women with T1-2 N1 breast cancer. The value of PMRT in this population has been questioned given advances in systemic therapy. The 21-gene recurrence score (RS) assay was evaluated as a predictor of OS among women with T1-2 N1 breast cancer who received or did not receive PMRT. Experimental Design: An observational cohort study was performed on women with T1-2 N1 estrogen receptor–positive breast cancer from the National Cancer Database (NCDB) and, as a validation cohort, from the surveillance, epidemiology, and end results (SEER) registry who underwent mastectomy and were evaluated for RS. Multivariable parametric accelerated failure time models were used to estimate associations of RS and PMRT with OS using propensity score-adjusted matched cohorts. Results: In both the NCDB (N ¼ 7,332) and SEER (N ¼ 3,087) cohorts, there was a significant interaction of RS and PMRT with OS (P ¼ 0.009 and P ¼ 0.03, respectively). PMRT was associated with longer OS in women with a low RS [NCDB: time ratio (TR) ¼ 1.70; 95% CI (confidence interval), 1.30–2.22; P < 0.001; SEER: TR ¼ 1.85; 95% CI, 1.33–2.57; P < 0.001], but not in women with an intermediate RS (NCDB: TR ¼ 0.89; 95% CI, 0.69–1.14; P ¼ 0.35; SEER: TR ¼ 0.84; 95% CI, 0.62–1.14; P ¼ 0.26), or a high RS (NCDB: TR ¼ 1.10; 95% CI, 0.91–1.34; P ¼ 0.33; SEER: TR ¼ 0.79; 95% CI, 0.50–1.23; P ¼ 0.28). Conclusions: Longer survival associated with PMRT was limited to women with a low RS. PMRT may confer the greatest OS benefit for patients at the lowest risk of distant recurrence. These results caution against omission of PMRT among women with low RS.

Original languageEnglish (US)
Pages (from-to)3878-3887
Number of pages10
JournalClinical Cancer Research
Volume24
Issue number16
DOIs
StatePublished - Aug 15 2018

Fingerprint

Mastectomy
Radiotherapy
Breast Neoplasms
Recurrence
Genes
Confidence Intervals
Survival
Epidemiology
Databases
Neoplasms
Propensity Score
Observational Studies
Registries
Estrogens
Cohort Studies
Research Design

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{a8f78ce5c175486cb6fc0787244610c7,
title = "21-gene recurrence score assay predicts benefit of post-mastectomy radiotherapy in T1-2 N1 breast cancer",
abstract = "Purpose: Post-mastectomy radiotherapy (PMRT) yields improvements in both locoregional control and overall survival (OS) for women with T1-2 N1 breast cancer. The value of PMRT in this population has been questioned given advances in systemic therapy. The 21-gene recurrence score (RS) assay was evaluated as a predictor of OS among women with T1-2 N1 breast cancer who received or did not receive PMRT. Experimental Design: An observational cohort study was performed on women with T1-2 N1 estrogen receptor–positive breast cancer from the National Cancer Database (NCDB) and, as a validation cohort, from the surveillance, epidemiology, and end results (SEER) registry who underwent mastectomy and were evaluated for RS. Multivariable parametric accelerated failure time models were used to estimate associations of RS and PMRT with OS using propensity score-adjusted matched cohorts. Results: In both the NCDB (N ¼ 7,332) and SEER (N ¼ 3,087) cohorts, there was a significant interaction of RS and PMRT with OS (P ¼ 0.009 and P ¼ 0.03, respectively). PMRT was associated with longer OS in women with a low RS [NCDB: time ratio (TR) ¼ 1.70; 95{\%} CI (confidence interval), 1.30–2.22; P < 0.001; SEER: TR ¼ 1.85; 95{\%} CI, 1.33–2.57; P < 0.001], but not in women with an intermediate RS (NCDB: TR ¼ 0.89; 95{\%} CI, 0.69–1.14; P ¼ 0.35; SEER: TR ¼ 0.84; 95{\%} CI, 0.62–1.14; P ¼ 0.26), or a high RS (NCDB: TR ¼ 1.10; 95{\%} CI, 0.91–1.34; P ¼ 0.33; SEER: TR ¼ 0.79; 95{\%} CI, 0.50–1.23; P ¼ 0.28). Conclusions: Longer survival associated with PMRT was limited to women with a low RS. PMRT may confer the greatest OS benefit for patients at the lowest risk of distant recurrence. These results caution against omission of PMRT among women with low RS.",
author = "Goodman, {Chelain R.} and Seagle, {Brandon Luke L.} and Masha Kocherginsky and Donnelly, {Eric Donald} and Shohreh Shahabi and Strauss, {Jonathan B}",
year = "2018",
month = "8",
day = "15",
doi = "10.1158/1078-0432.CCR-17-3169",
language = "English (US)",
volume = "24",
pages = "3878--3887",
journal = "Clinical Cancer Research",
issn = "1078-0432",
publisher = "American Association for Cancer Research Inc.",
number = "16",

}

21-gene recurrence score assay predicts benefit of post-mastectomy radiotherapy in T1-2 N1 breast cancer. / Goodman, Chelain R.; Seagle, Brandon Luke L.; Kocherginsky, Masha; Donnelly, Eric Donald; Shahabi, Shohreh; Strauss, Jonathan B.

In: Clinical Cancer Research, Vol. 24, No. 16, 15.08.2018, p. 3878-3887.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 21-gene recurrence score assay predicts benefit of post-mastectomy radiotherapy in T1-2 N1 breast cancer

AU - Goodman, Chelain R.

AU - Seagle, Brandon Luke L.

AU - Kocherginsky, Masha

AU - Donnelly, Eric Donald

AU - Shahabi, Shohreh

AU - Strauss, Jonathan B

PY - 2018/8/15

Y1 - 2018/8/15

N2 - Purpose: Post-mastectomy radiotherapy (PMRT) yields improvements in both locoregional control and overall survival (OS) for women with T1-2 N1 breast cancer. The value of PMRT in this population has been questioned given advances in systemic therapy. The 21-gene recurrence score (RS) assay was evaluated as a predictor of OS among women with T1-2 N1 breast cancer who received or did not receive PMRT. Experimental Design: An observational cohort study was performed on women with T1-2 N1 estrogen receptor–positive breast cancer from the National Cancer Database (NCDB) and, as a validation cohort, from the surveillance, epidemiology, and end results (SEER) registry who underwent mastectomy and were evaluated for RS. Multivariable parametric accelerated failure time models were used to estimate associations of RS and PMRT with OS using propensity score-adjusted matched cohorts. Results: In both the NCDB (N ¼ 7,332) and SEER (N ¼ 3,087) cohorts, there was a significant interaction of RS and PMRT with OS (P ¼ 0.009 and P ¼ 0.03, respectively). PMRT was associated with longer OS in women with a low RS [NCDB: time ratio (TR) ¼ 1.70; 95% CI (confidence interval), 1.30–2.22; P < 0.001; SEER: TR ¼ 1.85; 95% CI, 1.33–2.57; P < 0.001], but not in women with an intermediate RS (NCDB: TR ¼ 0.89; 95% CI, 0.69–1.14; P ¼ 0.35; SEER: TR ¼ 0.84; 95% CI, 0.62–1.14; P ¼ 0.26), or a high RS (NCDB: TR ¼ 1.10; 95% CI, 0.91–1.34; P ¼ 0.33; SEER: TR ¼ 0.79; 95% CI, 0.50–1.23; P ¼ 0.28). Conclusions: Longer survival associated with PMRT was limited to women with a low RS. PMRT may confer the greatest OS benefit for patients at the lowest risk of distant recurrence. These results caution against omission of PMRT among women with low RS.

AB - Purpose: Post-mastectomy radiotherapy (PMRT) yields improvements in both locoregional control and overall survival (OS) for women with T1-2 N1 breast cancer. The value of PMRT in this population has been questioned given advances in systemic therapy. The 21-gene recurrence score (RS) assay was evaluated as a predictor of OS among women with T1-2 N1 breast cancer who received or did not receive PMRT. Experimental Design: An observational cohort study was performed on women with T1-2 N1 estrogen receptor–positive breast cancer from the National Cancer Database (NCDB) and, as a validation cohort, from the surveillance, epidemiology, and end results (SEER) registry who underwent mastectomy and were evaluated for RS. Multivariable parametric accelerated failure time models were used to estimate associations of RS and PMRT with OS using propensity score-adjusted matched cohorts. Results: In both the NCDB (N ¼ 7,332) and SEER (N ¼ 3,087) cohorts, there was a significant interaction of RS and PMRT with OS (P ¼ 0.009 and P ¼ 0.03, respectively). PMRT was associated with longer OS in women with a low RS [NCDB: time ratio (TR) ¼ 1.70; 95% CI (confidence interval), 1.30–2.22; P < 0.001; SEER: TR ¼ 1.85; 95% CI, 1.33–2.57; P < 0.001], but not in women with an intermediate RS (NCDB: TR ¼ 0.89; 95% CI, 0.69–1.14; P ¼ 0.35; SEER: TR ¼ 0.84; 95% CI, 0.62–1.14; P ¼ 0.26), or a high RS (NCDB: TR ¼ 1.10; 95% CI, 0.91–1.34; P ¼ 0.33; SEER: TR ¼ 0.79; 95% CI, 0.50–1.23; P ¼ 0.28). Conclusions: Longer survival associated with PMRT was limited to women with a low RS. PMRT may confer the greatest OS benefit for patients at the lowest risk of distant recurrence. These results caution against omission of PMRT among women with low RS.

UR - http://www.scopus.com/inward/record.url?scp=85051714850&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051714850&partnerID=8YFLogxK

U2 - 10.1158/1078-0432.CCR-17-3169

DO - 10.1158/1078-0432.CCR-17-3169

M3 - Article

VL - 24

SP - 3878

EP - 3887

JO - Clinical Cancer Research

JF - Clinical Cancer Research

SN - 1078-0432

IS - 16

ER -