Algorithms for prediction of the Oncotype DX recurrence score using clinicopathologic data: a review and comparison using an independent dataset.
Algorithms for prediction of the Oncotype DX recurrence score using clinicopathologic data: a review and comparison using an independent dataset.
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DOI：
10.1007/s10549-016-4093-4
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发表时间：
2017-03
影响因子：
3.8
通讯作者：
Mazurowski MA
中科院分区：
文献类型：
--
作者：
Harowicz MR;Robinson TJ;Dinan MA;Saha A;Marks JR;Marcom PK;Mazurowski MA
考虑到成本和资源利用的潜在节省，已经提出了几种算法来使用常用的组织病理学变量预测Oncotype DX复发评分（ODX RS）。虽然有希望，但在指导患者管理之前，需要对这些替代标志物进行额外的独立验证。在这项回顾性研究中，我们分析了305例浸润性乳腺癌患者在我们的机构，有ODX RS可用。我们选择了五个方程，提供了ODX的替代措施，如以前发表的克莱因等。（Magee方程1-3），Gage et.例如，和Tang et.所有方程均使用雌激素受体状态和孕激素受体状态沿着不同的分级、增殖指数（Ki-67、有丝分裂率）、HER 2状态和肿瘤大小的组合。在所有测试的替代评分中，Magee方程2提供了与ODX在原始评分（Pearson相关系数= 0.66，95%CI 0.59-0.72）和分类相关性（Cohen kappa = 0.43，95%CI 0.33-0.53）方面的最高相关性。尽管Magee方程2提供了一种通过将95%的高ODX RS患者分配到中等或高风险组来可靠地识别高风险疾病的方法，但它无法通过ODX可靠地识别患者患有中等或高风险疾病的可能性（识别出66%的此类患者）。虽然ODX的常用替代物似乎预测高风险ODX RS，但它们不能可靠地排除ODX中等风险疾病患者的存在。考虑到辅助化疗在ODX中度风险疾病女性中的潜在益处，目前的替代品无法安全地替代ODX。通过ODX表征中等风险疾病患者的真实复发风险对于当前替代标志物的临床采用至关重要，并且是正在进行的临床试验的一个领域。
Given the potential savings in cost and resource utilization, several algorithms have been proposed to predict Oncotype DX recurrence score (ODX RS) using commonly acquired histopathologic variables. Although promising, additional independent validation of these surrogate markers is needed prior to guiding patient management. In this retrospective study, we analyzed 305 patients with invasive breast cancer at our institution that had ODX RS available. We selected five equations that provide a surrogate measure of ODX as previously published by Klein et. al. (Magee equations 1-3), Gage et. al., and Tang et. al. All equations used estrogen receptor status and progesterone receptor status along with different combinations of grade, proliferation indices (Ki-67, mitotic rate), HER2 status, and tumor size. Of all surrogate scores tested, the Magee equation 2 provided the highest correlation with ODX both with regards to raw score (Pearson’s correlation coefficient = 0.66 95% CI 0.59-0.72) and categorical correlation (Cohen’s kappa = 0.43, 95% CI 0.33-0.53). Although Magee equation 2 provided a way to reliably identify high risk disease by assigning 95% of the patients with high ODX RS to either the intermediate or high risk group, it was unable to reliably identify the potential for patients to have intermediate or high risk disease by ODX (66% of such patients identified). Although commonly available surrogates for ODX appear to predict high risk ODX RS, they are unable to reliably rule out the presence of patients with intermediate risk disease by ODX. Given the potential benefit of adjuvant chemotherapy in women with intermediate risk disease by ODX, current surrogates are unable to safely substitute for ODX. Characterizing the true recurrence risk in patients with intermediate risk disease by ODX is critical to the clinical adoption of current surrogate markers and is an area of ongoing clinical trials.
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