Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
Department of Radiation Oncology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
Clin Breast Cancer. 2014 Jun;14(3):182-90. doi: 10.1016/j.clbc.2013.12.002. Epub 2013 Dec 27.
Oncologists have used clinicopathologic features to guide treatment decisions for their breast cancer patients; however, more recently, results of multigene assays are also being considered. A popular assay, Oncotype DX (Genomic Health), stratifies node-negative breast cancer patients into groups that are at low, intermediate, or high risk for distant recurrence and guides decisions about adjuvant chemotherapy utilization.
We studied the impact of Oncotype DX recurrence score (ODxRS) compared with that of clinicopathologic features on adjuvant chemotherapy utilization in node-negative breast cancer patients and in node-positive breast cancer patients, and we evaluated whether clinicopathologic features impact the decision for adjuvant chemotherapy utilization in a subset of node-negative breast cancer patients with an intermediate-risk ODxRS.
A retrospective study from a single academic institution was performed on 425 patients with invasive breast carcinoma.
Adjuvant chemotherapy utilization most significantly correlated with a high-risk ODxRS (P < .0001) and, to a lesser degree, patient's age and tumor size. No statistically significant association was found between ODxRS and adjuvant chemotherapy utilization in a subset of patients. In the 156 node-negative breast cancer patients with intermediate-risk ODxRS, high tumor grade most significantly correlated with adjuvant chemotherapy utilization (P < .0001).
ODxRS, if available, heavily impacts adjuvant chemotherapy utilization and more so than any clinicopathologic factor in node-negative breast cancer patients. Node-negative breast cancer patients in the intermediate-risk group whose tumors were high grade were more likely to receive adjuvant chemotherapy.
肿瘤学家一直以来都依据临床病理特征来指导乳腺癌患者的治疗决策；但近来，多基因检测结果也被纳入考虑。一种广受欢迎的检测方法是 Oncotype DX（基因健康公司），它将淋巴结阴性乳腺癌患者分为低危、中危和高危远处复发风险组，并指导辅助化疗的使用决策。
我们研究了 Oncotype DX 复发评分（ODxRS）与临床病理特征对淋巴结阴性和阳性乳腺癌患者辅助化疗应用的影响，并评估了在 ODxRS 中危的淋巴结阴性乳腺癌患者亚组中，临床病理特征是否会影响辅助化疗的使用决策。
对单家学术机构的 425 例浸润性乳腺癌患者进行回顾性研究。
辅助化疗的应用与高危 ODxRS 显著相关（P<0.0001），其次是患者年龄和肿瘤大小。在亚组患者中，ODxRS 与辅助化疗的应用之间未发现统计学显著相关性。在 156 例 ODxRS 中危的淋巴结阴性乳腺癌患者中，高肿瘤分级与辅助化疗的应用显著相关（P<0.0001）。
ODxRS（如果可用）对辅助化疗的应用有重大影响，比淋巴结阴性乳腺癌患者的任何临床病理因素的影响都大。肿瘤分级较高的 ODxRS 中危淋巴结阴性乳腺癌患者更有可能接受辅助化疗。
