The impact of the Oncotype Dx breast cancer assay in clinical practice: a systematic review and meta-analysis.
The impact of the Oncotype Dx breast cancer assay in clinical practice: a systematic review and meta-analysis.
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DOI：
10.1007/s10549-013-2666-z
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发表时间：
2013-08
影响因子：
3.8
通讯作者：
Roth, Joshua A.
中科院分区：
文献类型：
--
作者：
Carlson, Josh J.;Roth, Joshua A.
Oncotype Dx （ODX）乳腺癌检测对辅助化疗（ACT）治疗决策的影响已经在许多先前的研究中进行了评估。然而，很难解释这些集体发现，这些发现是在不同的环境中进行的，样本量有限。我们进行了系统回顾和荟萃分析，以综合结果并提供有关ODX效用的见解。来自PubMed、Embase、ASCO和SABCS的研究纳入了患有ER+、淋巴结-、早期乳腺癌的患者，报告使用ODX来指导实际的ACT决策。根据(1)ODX复发评分（RS）的分布，(2)ODX对ACT推荐的影响，(3)ODX对ACT使用的影响，(4)接受ODX RS建议治疗的患者比例进行汇总，共有23项研究符合纳入标准。RS分类的分布为低48.8%，中39.0%，高12.2%（21项研究，4156例患者）。ODX改变了33.4%患者的临床病理ACT推荐（8项研究，1437例患者）。在接受ODX治疗的患者中，ACT的接受率为：28.2%总体，5.8%低，37.4%中等，83.4%高。高RS患者比低RS患者更有可能遵循ODX建议的治疗，RR: 1.07（1.01-1.14）。这些综合结果与迄今为止大多数单独研究的结果一致。相对于最初的估计，中间分数的比例增加可能对临床效用和测试的成本影响有影响。此外，与高RS相比，低RS患者更有可能遵循ODX结果，这表明尽管ODX RS高，但倾向于较不积极的治疗。最后，缺乏关于ODX对ACT使用与标准方法的影响的研究，这表明有必要进行更多的研究。
The impact of the Oncotype Dx (ODX) breast cancer assay on adjuvant chemotherapy (ACT) treatment decisions has been evaluated in many previous studies. However, it can be difficult to interpret the collective findings, which were conducted in diverse settings with limited sample sizes. We conducted a systematic review and meta-analysis to synthesize the results and provide insights about ODX utility. Studies, identified from PubMed, Embase, ASCO, and SABCS, were included if patients had ER+, node –, early-stage breast cancer, reported use of ODX to inform actual ACT decisions. Information was summarized and pooled according to: (1) distribution of ODX recurrence scores (RS), (2) impact of ODX on ACT recommendations, (3) impact of ODX on ACT use, and (4) proportion of patients following the treatment suggested by the ODX RS. A total of 23 studies met inclusion criteria. The distribution of RS categories was 48.8 % low, 39.0 % intermediate, and 12.2 % high (21 studies, 4,156 patients). ODX changed the clinical-pathological ACT recommendation in 33.4 % of patients (8 studies, 1,437 patients). In patients receiving ODX, receipt of ACT were: 28.2 % overall, 5.8 % low, 37.4 % intermediate, and 83.4 % high. High RS patients were significantly more likely to follow the treatment suggested by ODX versus low RS patients RR: 1.07 (1.01–1.14). The pooled results are consistent with most individual studies to date. The increased proportion of intermediate scores relative to original estimates may have implications for the clinical utility and cost impacts of testing. In addition, low versus high RS patients were significantly more likely to follow the ODX results, suggesting a tendency toward less aggressive treatment, despite a high ODX RS. Finally, there was a lack of studies on the impact of ODX on ACT use versus standard approaches, suggesting that additional studies are warranted.
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影响因子：
2.5
作者：
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通讯作者：
Soballe, Peter W.
影响因子：
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通讯作者：
Wood, W.
影响因子：
3.9
作者：
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通讯作者：
van't Veer, Laura
影响因子：
45.3
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