21基因复发风险评分对早期乳腺癌术后治疗决策的影响

Objective: To investigate the postoperative adjuvant therapeutic decision-oriented role of 21-gene recurrence score (RS) in hormone receptor positive and lymph node negative early stage breast cancer. Methods: Our study included 110 hormone receptor positive and lymph node negative early stage breast cancer patients who were tested for 21-gene RS and underwent surgical treatment between June 2013 and December 2016 at The First Affiliated Hospital of Xi'an Jiaotong University. According to the 21-gene RS, the included patients were divided into low-, intermediate- and high-risk groups. We compared the changes of treatment decisions before and after the 21-gene test. Results: Before taking the 21-gene test, 61 patients (55%) were recommended both adjuvant chemotherapy and endocrine therapy. However, after taking the test, 32 patients (29%) were treated with only adjuvant endocrine therapy (McNemar's test, P<0.001). Among them, in the low-risk and intermediate risk groups, 24 patients (39%) and 8 patients (20%) were respectively treated with only adjuvant endocrine therapy instead of adjuvant chemotherapy combined with endocrine therapy (McNemar's test, P<0.001; P=0.008) after taking the 21-gene test. Conclusion: For patients with hormone receptor positive and lymph node negative early stage breast cancer, taking the 21-gene test can significantly avoid excessive postoperative adjuvant chemotherapy in both low- and intermediate-risk groups. Moreover, it can reduce the postoperative chemotherapy rate and lessen the side effects of chemotherapy.