Center for Outcomes and Policy Research, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
J Clin Oncol. 2012 Jun 20;30(18):2218-26. doi: 10.1200/JCO.2011.38.5740. Epub 2012 May 14.
Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC).
By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use.
Of 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P < .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P < .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17).
There has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy.
基因表达谱（GEP）检测是一种相对较新的技术，为患者提供了个性化医疗的潜力，但人们对其在常规实践中的应用知之甚少。最早商业化的 GEP 测试之一是 21 基因检测，用于估计激素受体阳性乳腺癌（HR 阳性 BC）辅助化疗的益处。
我们使用前瞻性登记数据集，概述了 2006 年至 2008 年间在 17 个综合性和社区癌症中心诊断出 HR 阳性 BC 的女性接受的常规治疗，评估了 GEP 检测的采用情况以及检测与化疗使用之间的关联。
在 7375 名女性中，20.4%接受了 GEP 检测，50.2%接受了化疗。随着时间的推移，检测的使用有所增加（2006 年为 14.7%，2008 年为 27.5%；P<0.01），化疗的使用减少（2006 年为 53.9%，2008 年为 47.0%；P<0.01）。与检测几率较低独立相关的特征包括非裔美国人与白人种族（比值比[OR]，0.70；95%可信区间，0.54 至 0.92）和高中或以下学历与高中学历以上（OR，0.63；95%可信区间，0.52 至 0.76）。总体而言，检测与化疗使用几率较低相关（OR，0.70；95%可信区间，0.62 至 0.80）。分层分析表明，对于小的、淋巴结阴性的癌症，检测与化疗使用的几率增加相关（OR，11.13；95%可信区间，5.39 至 22.99），而对于淋巴结阳性和大的淋巴结阴性癌症，检测与化疗使用的几率降低相关（OR，0.11；95%可信区间，0.07 至 0.17）。
该 GEP 检测的使用逐渐增加，与接受辅助化疗的 HR 阳性 BC 女性的特征变化和总体比例降低相关。
