Breast (Edinburgh, Scotland) · 2026
The clinical value of clinical treatment score post-5 years in patients with premenopausal breast cancer: a retrospective analysis of ASTRRA trial.
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Han Yireh, Kim Hee Jeong, Baek Soo Yeon, Ahn Sei-Hyun, Ryu Jai Min, Kim Seung Il, Lee Eun-Gyeong, Im Seock-Ah, Jung Yongsik, Park Min Ho, Park Kyong Hwa, Kang Su Hwan, Jeong Joon, Park Eunhwa, Kim Sung Yong, Lee Min Hyuk, Kim Lee Su, Lim Woosung, Noh Woo Chul, Kim Seonok, Kim Hyun-Ah
Аннотация
BACKGROUND: The Clinical Treatment Score post-5 years (CTS5), a prognostic tool for late distant recurrence, was validated in postmenopausal patients, but its value in premenopausal women remains unclear. Using 8-year ASTRRA data, we evaluated the prognostic performance of CTS5 in premenopausal breast cancer patients.
METHODS: Patients without any event within the first 5 years were included in this analysis and were categorized into three risk groups based on CTS5 cutoff values. Late distant metastasis-free survival (DMFS) and overall survival were analyzed. Subgroup analyses were conducted to compare outcomes between the tamoxifen (TAM)-only and TAM + ovarian function suppression (OFS) groups.
RESULTS: Of the 1028 included premenopausal patients, late distant metastasis rates were 3.43% (low-risk, n = 466), 2.56% (intermediate-risk, n = 312), and 9.63% (high-risk, n = 270). The high-risk group showed a significantly higher risk of late DMFS compared to the low-risk group (HR = 3.32; 95% CI: 1.73-6.37; p < 0.001). The intermediate-risk group showed no significant difference (HR = 1.06; p = 0.876). When combining the low/intermediate-risk groups, the high-risk group maintained a significantly elevated risk (HR = 3.16; p = 0.015). OS results were consistent. Subgroup analysis confirmed that CTS5's prognostic ability was maintained in both the TAM-only (HR = 3.23; 0 = 0.004) and TAM + OFS groups (HR = 3.49; p = 0.029), consistently identifying high-risk patients.
CONCLUSION: In this randomized trial, unmodified CTS5 identifies high-risk patients but exhibits threshold inversions, making it unreliable for premenopausal extended therapy.
METHODS: Patients without any event within the first 5 years were included in this analysis and were categorized into three risk groups based on CTS5 cutoff values. Late distant metastasis-free survival (DMFS) and overall survival were analyzed. Subgroup analyses were conducted to compare outcomes between the tamoxifen (TAM)-only and TAM + ovarian function suppression (OFS) groups.
RESULTS: Of the 1028 included premenopausal patients, late distant metastasis rates were 3.43% (low-risk, n = 466), 2.56% (intermediate-risk, n = 312), and 9.63% (high-risk, n = 270). The high-risk group showed a significantly higher risk of late DMFS compared to the low-risk group (HR = 3.32; 95% CI: 1.73-6.37; p < 0.001). The intermediate-risk group showed no significant difference (HR = 1.06; p = 0.876). When combining the low/intermediate-risk groups, the high-risk group maintained a significantly elevated risk (HR = 3.16; p = 0.015). OS results were consistent. Subgroup analysis confirmed that CTS5's prognostic ability was maintained in both the TAM-only (HR = 3.23; 0 = 0.004) and TAM + OFS groups (HR = 3.49; p = 0.029), consistently identifying high-risk patients.
CONCLUSION: In this randomized trial, unmodified CTS5 identifies high-risk patients but exhibits threshold inversions, making it unreliable for premenopausal extended therapy.