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Evaluation of risk stratification using gene expression assays in patients with breast cancer receiving neoadjuvant chemotherapy

  • Epidemiology
  • Published:
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Abstract

Purpose

To evaluate the association of various gene expression assays with pathologic complete response (pCR) in the setting of neoadjuvant chemotherapy among patients with breast cancer

Methods

The National Cancer Database (NCDB) was queried for women diagnosed between 2010 and 2017 with stage I-III breast cancer who underwent neoadjuvant chemotherapy and either 21-gene recurrence score (RS) or 70-gene signature (GS). Logistic multivariable analysis (MVA) was performed to identify variables associated with pCR.

Results

A total of 3009 patients met our inclusion criteria. The median follow up was 48.0 months (interquartile range 32.2–66.7 months). On logistic MVA for all patients, those with a high risk from GS (adjusted odds ratio [aOR] 3.23, 95% confidence interval [CI] 1.49–8.13, p = 0.006) or with RS ≥ 31 (aOR 1.99, 95% CI 1.41–2.82, p < 0.001) were more likely to have pCR. When compared to RS ≥ 31, a high risk from GS was not associated with pCR (aOR 1.01, 95% CI 0.75–1.37, p = 0.94). However, among those with favorable hormone receptor status, similar findings were noted, except that those with a high risk group from GS were less likely to have pCR compared to those with RS ≥ 31 (aOR 0.65, 95% CI 0.43–0.96, p = 0.03). When analyses were repeated using a high risk group from RS defined as RS ≥ 26 among those with favorable hormone receptor status, RS ≥ 26 was not associated with pCR when compared to the high risk from GS (aOR 0.74, 0.50–1.07, p = 0.12).

Conclusions

To our knowledge, this is the largest study using a nationwide oncology database suggesting that high recurrence risk groups in both assays were associated with pCR. Among those with favorable hormone receptor status, RS ≥ 31 may be a more selective prognostic marker for pCR.

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Data availability

The primary dataset (National Cancer Database) is available publicly for investigators associated with Commission on Cancer-accredited programs through the American College of Surgeons (https://www.facs.org/quality-programs/cancer/ncdb).

Code availability

Codes used for statistical analyses are available upon specific requests.

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Acknowledgements

This work was supported by the National Cancer Institute Cancer Center Support Grant (P30CA016056).

Funding

The funding source had no involvement in the design, data collection, analysis, interpretation, or writing of this study.

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Authors and Affiliations

  1. Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY, 14203, USA

    Sung Jun Ma, Mark K. Farrugia & Anurag K. Singh

  2. Jacobs School of Medicine and Biomedical Sciences, University At Buffalo, The State University of New York, 955 Main Street, Buffalo, NY, 14203, USA

    Lucas M. Serra, Brian Yu & Austin J. Bartl

  3. Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, Gainesville, FL, 32610, USA

    Oluwadamilola T. Oladeru

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  1. Sung Jun Ma
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  2. Lucas M. Serra
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Contributions

Drs. Ma and Singh had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. SM—Study concept and design. All authors—Acquisition, analysis, or interpretation of data. SM, LS, BY—Drafting of the manuscript. All authors—Critical revision of the manuscript for important intellectual content. SM, BY—Statistical analysis. SM, AKS, OTO, SY—Administrative, technical, or material support. AKS, OTO, SY—Supervision.

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Correspondence to Anurag K. Singh.

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All authors declare that they have no competing interests.

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Our study was approved by Roswell Park Comprehensive Cancer Center institutional review board (BDR-131220).

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Ma, S.J., Serra, L.M., Yu, B. et al. Evaluation of risk stratification using gene expression assays in patients with breast cancer receiving neoadjuvant chemotherapy. Breast Cancer Res Treat 189, 737–745 (2021). https://doi.org/10.1007/s10549-021-06269-6

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  • DOI: https://doi.org/10.1007/s10549-021-06269-6

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