N. C. Vera4, D. Carr4, J. Mullinax1, D. Korz1, W. Sun1, C. Laronga1, S. Hoover1, W. Fulp2, G. Acs3, M. C. Lee1 1Moffitt Cancer Center And Research Institute,Breast Program,Tampa, FL, USA 2Moffitt Cancer Center And Research Institute,Biostatistics,Tampa, FL, USA 3Women’s Pathology Consultants,Ruffolo Hooper & Associates,Tampa, FL, USA 4University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: Treatment planning for locally recurrent estrogen receptor positive (ER+) invasive breast cancer is controversial. The Recurrence Score (RS) from the 21-gene breast cancer assay (ODX) is commonly used for primary early stage ER+ invasive breast cancer for adjuvant treatment recommendations, but not generally obtained in locally recurrent ER+ tumors. We reviewed our experience with RS first performed on the recurrent tumor.
Methods: An IRB-approved, single-institution retrospective chart review of a prospective ODX database was performed. Most patients had ODX performed on an initial invasive breast cancer (1o cancer); another set of patients, the minority, had ODX performed on an ipsilateral local recurrence/new primary (2nd cancer); none had clinical evidence of concurrent regional or distant metastasis at presentation. Performance of the ODX assay was based on NCCN guidelines (1o cancer) or physician discretion (2nd cancer). Data collected included demographics, clinical-pathologic variables, surgery type, RS, adjuvant treatment and outcomes. Comparisons between patients with 1o breast cancer and patients with 2nd cancers were made by general linear regression model and the exact Wilcoxon Rank Sum Test.
Results:594 patients with 1o breast cancer and 7 patients with 2nd breast cancer had ODX and RS. Median age of patients at time of ODX was 58 years (range 27-84) for 1o cancer and 58.5 years (range 36-63) for 2nd cancers (p=0.411) respectively. The majority of patients with a 2nd breast cancer had a prior history of breast conservation (6/7). Median invasive tumor size of 1o cancer was 1.5cm and 2nd cancer was 1.4cm. One 2nd cancer was ILC, otherwise all documented 1o and 2nd breast cancers were ER+ and of invasive ductal histology. For 2nd cancers, median time from 1o breast cancer surgery to diagnosis with 2nd breast cancer was 92 months (range 13-120)[Table of 2nd cancers]. Median RS was higher in patients with 2nd cancer at 22 (range 15-37) compared to 1o cancer at 16 (range 0-63) (p=0.03). Categorically, more 2nd cancer patients had a high RS (28.6%) than those with 1o cancer (8.1%) but it was not significant (p=0.08). Tumor size, nodal status, degree of ER expression, nuclear grade, number of mitoses, and compliance with endocrine therapy were not significantly different between patients with 2nd cancer and 1o cancer. Overall survival tended to be better in patients with 1o breast cancer (P=0.049).
Conclusion:Performance of ODX in ER+, locally recurrent/new primary invasive breast cancer (2nd breast cancer) should be considered for prognostication and adjuvant systemic treatment recommendations.
