21基因复发风险评分在激素受体阳性乳腺癌患者中的应用

Application of 21⁃gene Recurrence Score in Hormone Receptor Positive Breast Cancer Patients

近10年来,随着精准医疗的发展,乳腺癌的治疗进入了一个新时代,即在不影响生存结果的前提下,趋向于治疗降级、方案个体化,在给患者带来最大获益的同时尽可能减少医源性毒性暴露。21基因复发风险评分(21-gene recurrence score, RS)能够评估乳腺癌患者复发风险和化疗获益,已被美国临床肿瘤学会、美国国家综合癌症网络及中国抗癌协会推荐用于指导激素受体阳性、人类表皮生长因子受体2阴性的早期乳腺癌患者辅助治疗,但其临床应用尚存有争议。目前的研究主要聚焦于RS的临床优化,以更加准确地识别可从辅助治疗中受益的患者,使乳腺癌患者的治疗方案更加个体化。本文主要就RS在激素受体阳性乳腺癌患者辅助治疗中的应用、RS对临床决策的影响、RS面临的争议与应用前景等方面进行综述,以期指导临床进一步扩展RS的应用范围,使乳腺癌患者的辅助治疗更加精准。

In the past decade,with the introduction of precision medicine,the treatment of breast cancer has entered a new era.It now tends towards the de-escalation and individualization of treatment plans,aiming to minimize iatrogenic toxicity while maximizing benefits for patients without compromising survival out-comes.The 21-gene assay evaluates the expression levels of 21 genes associated with breast cancer recurrence and provides a 21-gene recurrence score(RS)to assess the risk of recurrence and potential benefit from chemotherapy in breast cancer patients.Currently,RS is recommended by multiple guidelines such as the American Society of Clinical Oncology(ASCO),National Comprehensive Cancer Network(NCCN),and Chinese Anti-Cancer Association(CACA)for guiding adjuvant therapy in hormone receptor-positive(HR+)and human epidermal growth factor receptor 2 negative(HER2-)early-stage breast cancer patients.However,there are still controversies surrounding its clinical application.Current research mainly focuses on optimi-zing RS to accurately identify patients who would benefit from adjuvant therapy,thus enabling more per-sonalized treatment plans for breast cancer patients.This review provides an overview of the 21-gene assay,its application in HR+breast cancer patients'adjuvant therapy,its impact on clinical decision-making,ex-isting controversies regarding RS,and prospects for integrating RS with clinical pathological information.The aim is to guide further expansion of RS's application in clinical practice and achieve more precise adju-vant therapy for breast cancer patients.