A Multigene Assay to Predict Recurrence of Tamoxifen-Treated, Node-Negative Breast Cancer
Soonmyung Paik, M.D., Steven Shak, M.D., Gong Tang, Ph.D., Chungyeul Kim, M.D., Joffre Baker, Ph.D., Maureen Cronin, Ph.D., Frederick L. Baehner, M.D., Michael G. Walker, Ph.D., Drew Watson, Ph.D., Taesung Park, Ph.D., William Hiller, H.T., Edwin R. Fisher, M.D., D. Lawrence Wickerham, M.D., John Bryant, Ph.D., and Norman Wolmark, M.D.
Background The likelihood of distant recurrence in patientswith breast cancer who have no involved lymph nodes and estrogen-receptorpositivetumors is poorly defined by clinical and histopathological measures.
Methods We tested whether the results of a reverse-transcriptasepolymerase-chain-reaction(RT-PCR) assay of 21 prospectively selected genes in paraffin-embeddedtumor tissue would correlate with the likelihood of distantrecurrence in patients with node-negative, tamoxifen-treatedbreast cancer who were enrolled in the National Surgical AdjuvantBreast and Bowel Project clinical trial B-14. The levels ofexpression of 16 cancer-related genes and 5 reference geneswere used in a prospectively defined algorithm to calculatea recurrence score and to determine a risk group (low, intermediate,or high) for each patient.
Results Adequate RT-PCR profiles were obtained in 668 of 675tumor blocks. The proportions of patients categorized as havinga low, intermediate, or high risk by the RT-PCR assay were 51,22, and 27 percent, respectively. The KaplanMeier estimatesof the rates of distant recurrence at 10 years in the low-risk,intermediate-risk, and high-risk groups were 6.8 percent (95percent confidence interval, 4.0 to 9.6), 14.3 percent (95 percentconfidence interval, 8.3 to 20.3), and 30.5 percent (95 percentconfidence interval, 23.6 to 37.4). The rate in the low-riskgroup was significantly lower than that in the high-risk group(P<0.001). In a multivariate Cox model, the recurrence scoreprovided significant predictive power that was independent ofage and tumor size (P<0.001). The recurrence score was alsopredictive of overall survival (P<0.001) and could be usedas a continuous function to predict distant recurrence in individualpatients.
Conclusions The recurrence score has been validated as quantifyingthe likelihood of distant recurrence in tamoxifen-treated patientswith node-negative, estrogen-receptorpositive breastcancer.
Source Information
From the Division of Pathology, Operation Center, and the Biostatistics Center, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh (S.P., G.T., C.K., T.P., W.H., E.R.F., D.L.W., J.B., N.W.); Genomic Health, Redwood City, Calif. (S.S., J.B., M.C., M.G.W., D.W.); the Department of Statistics, University of Pittsburgh, Pittsburgh (G.T., J.B.); and the University of California, San Francisco, San Francisco (F.L.B.).
Address reprint requests to Dr. Paik at the Division of Pathology, NSABP, 4 Allegheny Center, 5th Fl., East Commons Professional Bldg., Pittsburgh, PA 15212, or at spaik.nejm{at}nsabp.org.
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