Abstract
Background
More than 50% of estrogen receptor (ER)-positive breast cancer (BC) distant recurrences
(DR) develop after the completion of 5 years of adjuvant endocrine therapy (ET). Its
extension is beneficial on disease-free survival and overall survival but increases
therapy-related side effects. Selecting patients who could benefit the most from an
extended regimen has become an increasing need. Clinical Treatment Score at 5 Years
(CTS5) is a prognostic tool using clinicopathologic data to estimate DR risk after
5 years of ET for ER+ BC. We sought to validate the prognostic value of CTS5 in a retrospective cohort
of real-life pre- and postmenopausal patients diagnosed with ER+ BC.
Patients and Methods
CTS5 was calculated for 603 patients diagnosed with ER+ BC at Umberto I Hospital of Turin and DR-free after 5 years of ET. Primary endpoint
was late DR (LDR) rate.
Results
Median follow-up was 8 years (range, 6-26 years). The 426 postmenopausal women were
categorized by CTS5 as follows: 152 low risk, 139 intermediate risk, and 135 high
risk. LDR rates were 3.9%, 7.2%, and 15.6%, respectively. CTS5 results were prognostic
for LDR: patients with CTS5-high showed a fourfold risk of developing an LDR compared
to patients with CTS5-low (hazard ratio, 4.48; 95% confidence interval, 1.80-11.1).
The same analysis was conducted for the 177 premenopausal women: 88 low risk, 40 intermediate
risk, and 49 high risk. LDR rate were 5.6%, 7.5%, and 20.4%, respectively, proving
CTS5 to be prognostic for premenopausal patients as well (CTS5-high vs. CTS5-low:
hazard ratio, 3.40; 95% confidence interval, 1.06-11.0).
Conclusion
CTS5 was shown to be prognostic of the risk of LDR in our population of real-life
pre- and postmenopausal patients. Our results support its use in clinical practice
to better tailor the prescription of extended ET.
Keywords
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Article info
Publication history
Published online: June 30, 2020
Accepted:
June 24,
2020
Received in revised form:
June 23,
2020
Received:
March 3,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
