Breast Medical Oncologists' Use of Standard Prognostic Factors to Predict a 21-Gene Recurrence Score
Breast Medical Oncologists' Use of Standard Prognostic Factors to Predict a 21-Gene Recurrence Score
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DOI：
10.1634/theoncologist.2011-0048
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发表时间：
2011-10-01
期刊：
影响因子：
5.8
通讯作者：
Goetz, Matthew P.
中科院分区：
文献类型：
--
作者：
Kamal, Arif H.;Loprinzi, Charles L.;Goetz, Matthew P.
背景资料。所有乳腺癌中有一半是早期的，淋巴结阴性，激素受体阳性。21基因(Oncotype DX(R)；基因健康公司，加利福尼亚州雷德伍德市)复发评分(RS)是复发的预后和化疗益处的预测。我们探讨了肿瘤学家使用标准预后标准预测RS的能力。方法：研究方法。标准的人口学和肿瘤预后标准从有RS的患者中获得。两位学术病理学家提供了肿瘤分级、组织类型和激素受体状态。六位学术肿瘤学家预测了RS类型(低、中或高)，并提供了治疗建议。然后，肿瘤学家被给予实际的RS，并提供治疗建议。进行一致性分析。结果。31例，包括另外9例变异的病理读物，被提出。肿瘤学家在区分真低、真中和真高之间的能力有很大的一致性(kappa=0.75；p<；0.0001)。低位和中位之间的预测并不一致。最常见的差异是当病例为真中等时预测RS风险较低，而当病例为真低时预测为中等RS风险。实际的RS导致19%的病例的治疗建议发生了变化。在186种方案和总共6名肿瘤学家中，实际RS导致的化疗建议减少了5项。结论。肿瘤学家能够使用标准的预后标准来区分低度或中度RS和高度RS。然而，实际RS的提供改变了近20%的病例的治疗建议，这表明RS可能会减少化疗的使用。这一效果在中等风险病例中尤其明显。有必要进行前瞻性临床试验，以确定基于RS的决定是否会改变结果。肿瘤学家2011；16：1359-1366
Background. Half of all breast cancers are early stage, lymph node negative, and hormone receptor positive. A 21-gene (Oncotype DX (R); Genomic Health, Inc., Redwood City, CA) recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit. We explored the ability of oncologists to predict the RS using standard prognostic criteria. Methods. Standard demographic and tumor prognostic criteria were obtained from patients with an available RS. Two academic pathologists provided tumor grade, histologic type, and hormone receptor status. Six academic oncologists predicted the RS category (low, intermediate, or high) and provided a recommendation for therapy. The oncologists were then given the actual RS and provided recommendations for therapy. Analysis for agreement was performed. Results. Thirty-one cases, including nine additional cases with variant pathology reads, were presented. There was substantial agreement in oncologists' ability to discriminate between true low or true intermediate and true high (kappa = 0.75; p < .0001). Predictions between low and intermediate were not consistent. The most common discrepancies were predictions of a low RS risk when cases were true intermediate and predictions of an intermediate RS risk when cases were true low. The actual RS resulted in a change in the treatment recommendations in 19% of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer chemotherapy recommendations resulted with the actual RS. Conclusions. Oncologists are able to differentiate between a low or intermediate RS and a high RS using standard prognostic criteria. However, provision of the actual RS changed the treatment recommendations in nearly 20% of cases, suggesting that the RS may reduce chemotherapy use. This effect was observed in particular in intermediate-risk cases. Prospective clinical trials are necessary to determine whether decisions based on the RS change outcomes. The Oncologist 2011; 16: 1359-1366