The value of multigene predictors of clinical outcome in breast cancer: an analysis of the evidence.
The value of multigene predictors of clinical outcome in breast cancer: an analysis of the evidence.
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DOI：
10.1586/14737159.2015.983476
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发表时间：
2015-02
影响因子：
5.1
通讯作者：
Marchant GE
中科院分区：
文献类型：
--
作者：
Issa AM;Chaudhari VS;Marchant GE
多基因预测因子越来越多地用于早期乳腺癌患者的预测和预后。然而，多基因预测因子使用的增加以及将其纳入常规临床实践的努力的加强的一个后果是未来医疗事故诉讼的可能性。因此，重要的是要确定使用不同的市售多基因预测分析临床证据的强度。我们评估了文献中四种目前可用的基因标签的临床有效性的证据，并评估了21-基因表达测定Oncotype DX®（Genomic Health Inc.，红杉城，加利福尼亚州，美国）的治疗建议的变化。对2002年1月至2014年3月的同行评议文献进行了系统检索，以获得多基因预测因子检测，并进行了荟萃分析。符合合格性标准的研究的校正后考克斯风险比平均值为3.538（95% CI：1.513 - 8.469）。21个基因签名在估计远处复发风险的可能性方面显示出最高的稳定性。使用复发评分导致研究中31.8%的患者的治疗建议发生变化。这项研究可能会提供洞察多基因预测因子在临床实践中的预测和预后乳腺癌的使用。
Multigene predictors are being used increasingly in early stage breast cancer patients for prediction and prognosis. However, one consequence of the increased use of multigene predictors, and the heightened efforts towards their incorporation into routine clinical practice, is the potential for future malpractice litigation. It is therefore important to ascertain the strength of the evidence for using the different commercially available multigene predictor assays clinically. We evaluated the literature for evidence of clinical validity of four currently available gene signatures, and to assess the influence of the 21-gene-expression assay Oncotype DX® (Genomic Health Inc., Redwood City, CA, USA) on changes in treatment recommendations. A systematic search of the peer-reviewed literature from January 2002 to March 2014 for multigene predictor assays was carried out, and a meta-analysis was conducted. The adjusted Cox hazard ratio average for studies that met eligibility criteria was 3.538 (95% CI: 1.513 – 8.469). The 21-gene signature showed the highest stability in the estimation of likelihood of distant risk of recurrence. Using recurrence scores resulted in changes in treatment recommendations in 31.8% of all patients in the studies. This study may provide insight about the use of multigene predictors in clinical practice for prediction and prognosis in breast cancer.