Evaluating patterns of utilization of gene signature panels and impact on treatment patterns in patients with ductal carcinoma in situ of the breast
Evaluating patterns of utilization of gene signature panels and impact on treatment patterns in patients with ductal carcinoma in situ of the breast
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DOI：
10.1016/j.surg.2019.04.044
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发表时间：
2019-10-01
期刊：
影响因子：
3.8
通讯作者：
Ajkay, Nicolas
中科院分区：
文献类型：
--
作者：
Bhutiani, Neal;Vuong, Brooke;Ajkay, Nicolas
背景：基因特征组 Oncotype DX DCIS 的广泛使用模式及其对乳腺导管原位癌女性术后放射治疗的大规模影响仍不清楚。本研究旨在评估该基因特征组在导管原位癌女性中的使用模式以及这些工具对术后放射治疗管理的影响。方法：查询国家癌症数据库，查找接受保乳治疗的导管原位癌女性，这些女性有关于 2010 年至 2015 年间是否进行基因特征组的信息。对患者之间的人口统计学特征、导管原位癌的特征以及是否接受术后放射治疗进行比较谁进行了基因签名小组测试，谁没有进行。放射治疗的管理模式也根据基因特征面板的复发风险评分进行评估。结果：基因特征面板的使用随着时间的推移而增加，2015 年的利用率急剧增加（2015 年为 8.0%，2014 年为 4.4%，P < .001）。雌激素受体阳性导管原位癌患者更有可能获得基因特征组（3.9% 雌激素受体阳性 vs 1.7% 雌激素受体阴性，P < 0.001），低级别导管原位癌患者也是如此（4.5% I/II 级 vs 3.1% III 级，P < .001）。基因特征面板的使用与术后放射治疗的减少相关（48.6% 基因特征面板 vs 83.4% 无基因特征面板，P < .001）。在进行基因特征检测的患者中，高、中、低复发评分的患者中分别有 81.9%、72.0% 和 35.9% 的患者接受了术后放射治疗。结论：基因特征检测在导管原位癌患者中的使用随着时间的推移而增加，并且更常用于具有较低风险、临床病理特征的女性，以确定放射治疗所带来的获益程度。基因特征面板的使用与术后放射治疗施用率降低相关，特别是在评分表明复发率较低的患者中。 (C) 2019 Elsevier Inc. 保留所有权利。
Background: Broad patterns of use of the gene signature panel Oncotype DX DCIS and its large-scale impact on postoperative administration of radiation therapy in women with ductal carcinoma in situ of the breast remain unclear. This study sought to evaluate the patterns of use of this gene signature panel in women with ductal carcinoma in situ and the impact of these tools on postoperative radiation therapy administration.Methods: The National Cancer Database was queried for women with ductal carcinoma in situ treated with breast-conserving therapy who had information regarding whether a gene signature panel was performed between 2010 and 2015. Demographic characteristics, the characteristics of their ductal carcinoma in situ, and whether they received postoperative radiation therapy were compared among patients who did have a gene signature panel performed and those who did not. Patterns of radiation therapy administration were also evaluated based on the recurrence risk score by the gene signature panel.Results: Gene signature panel use increased over time, with a sharp increase in utilization occurring in 2015 (8.0% in 2015 vs 4.4% in 2014, P < .001). Patients with estrogen receptor positive ductal carcinoma in situ were somewhat more likely to have a gene signature panel ordered (3.9% estrogen receptor positive vs 1.7% estrogen receptor negative, P < .001), as were patients with lower-grade ductal carcinoma in situ (4.5% grade I/II vs 3.1% grade III, P < .001). Gene signature panel utilization was associated with a decrease in the administration of postoperative radiation therapy (48.6% gene signature panel vs 83.4% no gene signature panel, P < .001). Among patients in whom a gene signature panel was performed, postoperative radiation therapy was administered in 81.9%, 72.0%, and 35.9% of patients with high-, intermediate-, and low-recurrence scores, respectively.Conclusion: Gene signature panel use in patients with ductal carcinoma in situ has increased over time and is more commonly used in women with lower-risk, clinicopathologic features to determine the magnitude of benefit afforded by radiation therapy. Gene signature panel use is associated with decreased rates of postoperative radiation therapy administration, particularly among patients with scores suggesting a low rate of recurrence. (C) 2019 Elsevier Inc. All rights reserved.