STEPP Analysis To Guide The Study Of Endocrine Prolongation Therapy For Postmenopausal Breast Cancer

Background and objectives: After 5 years of systemic endocrine therapy,some postmenopausal hormone receptor positive breast cancer patients are still at risk of long-term recurrence and metastasis.Prolonged endocrine therapy improves survival,but increases treatment-related side effects.How to screen the beneficial population of intensive therapy remains controversial.The risk prediction model is a good predictor of prognosis.One is STEPP,the other is CTS5,and the third is St.Gallen risk stratification.STEPP analysis has been used in premenopausal patients,but its use in postmenopausal patients has not been demonstrated.CTS5 analysis and St.Gallen analysis can be used in postmenopausal patients.Therefore,the main objective of this study was to validate the predictive efficacy of STEPP analysis for long-term recurrence and metastasis in postmenopausal patients who had completed 5 years of endocrine therapy.Methods:A total of 228 breast cancer patients from 2004 to 2009 in the Department of Breast Surgery of the First Affiliated Hospital of China Medical University were selected and followed up for 10 years.All patients were divided into two groups according to whether recurrence,of which 62 cases were in recurrence group and 166 cases were in non-recurrence group.The influencing factors of recurrence were analyzed.STEPP score(1.59)was used as cut-off value,CTS5 score(3.13,3.86)were used as cut-off value,St.Gallen risk stratification was used to compare the survival of patients in different groups of three risk prediction models.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive efficacy of STEPP、CTS5、St.Gallen analysis.Pearson correlation analysis of three models was performed.Results: The median follow-up time was 113.2 months.Univariate analysis in this study showed that tumor grade,tumor diameter,axillary lymph node metastasis,Ki-67 level and STEPP score may be associated with recurrence and metastasis(P<0.05).Multivariate analysis showed that tumor diameter(> 2cm),axillary lymph node metastasis,high Ki-67 expression(> 14%)and STEPP score(> 1.59 score)may be independent risk factors.Survival analysis shows STEPP,CTS5 and St.Gallen disease-free survival(DFS)and total survival(OS)were significantly reduced in the high-risk group.The area under the curve was 0.904,the sensitivity was 82.5%,and the specificity was 87.7%,it had good efficacy in predicting recurrence and metastasis.The area under the curve of CTS5 and St.Gallen analysis were 0.919 and 0.791,which also had good prediction performance in this data.Pearson analysis showed that STEPP and CTS5 and St.Gallen have a significant correlation.Conclusion: The data of this study show that STEPP analysis can be used to evaluate the risk of long-term recurrence and metastasis of postmenopausal hormone receptor positive breast cancer patients.Patients with STEPP score >1.59 have a higher risk of recurrence and metastasis.It can be recommended to extend endocrine therapy and improve long-term survival,which has a high predictive effect.The conclusion of this paper needs to be confirmed by follow-up prospective studies.