Analysis Of The Results Of 21 Gene Recurrence Risk Score In 35 Patients With Early Breast Cancer

[Objective]Breast cancer is the cancer with the highest incidence in Chinese women.With the popularization of breast cancer screening and the advancement of medical imaging,more and more patients with early breast cancer(EBC)have been found clinically.Currently,surgery is the mainstay,supplemented by radiotherapy,chemotherapy,and endocrine therapy The comprehensive treatment model has significantly reduced the mortality and recurrence rate of breast cancer,and is currently targeted at early clinical breast cancer(EBC)patients with hormone receptor(HR)positive and human epidermal growth factor receptor 2(HER2)negative At present,the benefits of chemotherapy are not completely clear,and there is the possibility of overtreatment.How to balance the risk of recurrence with the potential benefit of chemotherapy,reduce unnecessary chemotherapy,and improve the quality of life of patients is a major hotspot in the field of EBC treatment.With the development of genomics,genetic testing has shown its full potential and prospects in the prognosis and prediction of breast cancer,including 21 genetic testing,70 genetic testing and microarray 50(PAM50)prediction technology,etc.,21 genes The application value of detection technology has been verified by many clinical trials.The 21-gene recurrence score(RS)is calculated by detecting the expression of 21 genes.The 21 Gene Recurrence Score(RS)quantifies the risk of early breast cancer recurrence and predicts the benefits of chemotherapy for such patients.For this part of EBC patients with ER(+)and HER2(-),the results of many clinical trials suggest that the 21 gene recurrence risk score RS can not only predict the prognosis of the patient,but also determine whether it is necessary to add adjuvant chemotherapy on the basis of postoperative endocrine therapy.Therefore,the 21 gene recurrence risk score has been successively written into various clinical guidelines such as NCCN,ESMO,ASCO and St.Gallen consensus and used to guide the clinical treatment decisions of these patients.However,the high cost of 21 gene testing and the complexity of testing technology Due to the fact that there are still few domestic related clinical trials,this study analyzed the 21 gene recurrence risk score(RS)classification and the maximum diameter of tumors in early breast cancer patients,patient age,histological typing,PR status,Ki-67 expression,etc.The relationship between clinical pathology characteristics,with a view to improving the understanding of the relationship between the 21 gene recurrence risk score(RS)and traditional clinical pathology characteristics,and providing clinical treatment reference.And to explore the impact of 21 gene recurrence risk score on clinicians’ postoperative adjuvant treatment decision-making,and further verify the applicability of 21 gene detection in clinical diagnosis and treatment in my country.[Method]This experiment collected data from a total of 45 early breast cancer patients admitted to the Breast Surgery Department of the First Affiliated Hospital of Kunming Medical University from January 2018 to November 2019.Among them,35 patients with complete clinical and pathological data and eligible income included 35 of them.Collect patient cases and case data including:21 gene recurrence score(RS),tumor size,lymph node metastasis,clinical stage,histological grade of postoperative specimens,hormone receptors in immunohistochemical results,Her-2 and Ki-67 Expression,patient age,recurrence,and condition at last follow-up.According to the 21 gene recurrence risk scoring criteria,it was divided into low-risk and medium-high risk groups.The data were integrated to explore and analyze the correlation between the 21-gene RS score and various clinical indicators,and compare the changes in treatment decisions before and after the 21-gene test.All data are analyzed with SPSS20.0 statistical software,and count data are described by frequency and percentage.Chi-square test is used for counting data,paired chi-square test is used for matching design data,and Fisher’s exact probability method is used if the conditions of chi-square test are not met.P＜0.05 was considered statistically significant.[Result]1.Of the 45 patients,a total of 4 were missing clinical data,6 were lost to follow-up,and finally included 35 effective patients,including clinical pathology data including patient age,postoperative specimen histological grade,pathological type,ER status,PR Status,Ki-67 status,tumor maximum diameter(cm),surgical method,axillary lymph node status,menstrual status,and divided into low-risk group,medium-risk group,and high-risk group according to the 21 gene recurrence risk score(RS)25 cases(71.4%)in the low recurrence risk group,8 cases(22.9%)in the middle recurrence risk group,and 2 cases(5.7%)in the high recurrence risk.The RS grading of the enrolled patients was related to tumor histological grading and Ki-67 expression(both P＜0.05).However,there was no statistically significant difference in age,PR status,menstrual status,tumor diameter,pathological type,and surgical method in different RS grades(all P＞0.05).2.The diagnosis and treatment team made independent treatment decisions before and after the RS score,and conducted two discussions before and after the patient completed the 21 gene test.After the 21 gene recurrence risk score,a total of 13 patients(37.1%)of 35 patients had changed their adjuvant treatment decisions.Among breast cancer patients stratified into low-and medium-risk groups,chemotherapy was combined with endocrine therapy 10 cases(40.0%)and 3 cases(37.5%)were changed to adjuvant endocrine therapy alone,and 1 case(12.5%)was changed from simple endocrine adjuvant therapy to chemotherapy combined with endocrine therapy(12.5%)(McNemar’s test,P＜0.05;P=0.003),the differences in physicians’ treatment decisions before and after genetic testing were statistically significant..3.Before performing the 21-gene test,of all the patients who met the enrollment criteria,35 patients were recommended as adjuvant chemotherapy+adjuvant endocrine therapy(CHT)after surgery.A total of 25 patients(57.1%).A total of 15 patients(42.9%)were recommended as adjuvant endocrine therapy after adjuvant therapy.However,after 21 genetic testing,74.3%of the patients were recommended to be exempted from chemotherapy.Compared with the initial adjuvant therapy recommendations and the adjuvant therapy recommendations after the RS score,RS has a significant effect on the rate of change of adjuvant therapy options for such patients(p＜0.05),suggesting that for EBC patients with hormone receptor positive,HER(2)negative,and axillary lymph node metastasis negative,increasing the 21 gene recurrence risk score can significantly affect the clinician’s decision-making for adjuvant treatment options for EBC patients and reduce The rate of postoperative chemotherapy in EBC patients.4.As of December 31,2019,with a median follow-up of 10.5 months,one of the 35 patients had local recurrence and no distant metastasis or death.The pathological type of this patient was mucinous carcinoma with ductal carcinoma in situ.Local recurrence occurred after 9 months of follow-up.The RS score was low risk of recurrence(8.4868),and no adjuvant chemotherapy was performed.[conclusion]1.The 21 gene recurrence risk score can affect the decision-making of adjuvant treatment for early breast cancer patients with hormone receptor positive and lymph node negative,and reduce the postoperative chemotherapy rate.2.In patients with early breast cancer,the 21 gene recurrence risk score grade is correlated with histological grade and Ki-67 expression.3.In patients with early breast cancer,the 21 gene recurrence risk score has no significant correlation with age,PR status,menstrual status,pathological type,tumor maximum diameter,and surgical method.4.The 21 genetic test helps to provide quantified treatment decision and prognosis information for individual patients,and has a wide application prospect in individualized precision treatment.