Cress Rosemary D, Chen Yingjia S, Morris Cyllene R, Chew Helen, Kizer Kenneth W
Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA.
Cancer Registry of Greater California, Public Health Institute, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA.
Cancer Causes Control. 2016 Jun;27(6):721-7. doi: 10.1007/s10552-016-0743-4. Epub 2016 Apr 20.
To describe the utilization of gene expression profiling (GEP) among California breast cancer patients, identify predictors of use of GEP, and evaluate how utilization of GEP influenced treatment of early-stage breast cancer.
All women diagnosed with hormone-receptor-positive, node-negative breast cancer reported to the California Cancer Registry between January 2008 and December 2010 were linked to Oncotype DX (ODX) assay results.
Overall, 26.7 % of 23,789 eligible patients underwent the assay during the study period. Women age 65 or older were much less likely than women under age 50 to be tested (15.1 vs. 41.4 %, p < 0.001). Black women were slightly less likely and Asian women were slightly more likely than non-Hispanic white women to undergo GEP with the ODX assay (22.2 and 28.9 vs. 26.9 %, respectively, p < 0.001). Patients residing in low SES census tracts had the lowest use of the test (8.9 %), with the proportion increasing with higher SES category. Women with Medicaid health insurance were less likely than other women to be tested (17.7 vs. 27.5 %, p < 0.001). Receipt of adjuvant chemotherapy (ACT) was associated with the ODX recurrence score, although only 63 % of patients whose recurrence scores indicated a high benefit received ACT. Of patients not tested, 15 % received ACT.
Nearly three-fourths of eligible breast cancer patients in California during the 3-year period 2008 through 2010 did not undergo GEP. As a result, it is likely that many women unnecessarily received ACT and suffered associated morbidity. In addition, some high-risk women who would have benefited most from ACT were not identified.
描述加利福尼亚州乳腺癌患者中基因表达谱分析（GEP）的应用情况，确定GEP使用的预测因素，并评估GEP的应用如何影响早期乳腺癌的治疗。
2008年1月至2010年12月期间向加利福尼亚癌症登记处报告的所有诊断为激素受体阳性、淋巴结阴性乳腺癌的女性均与Oncotype DX（ODX）检测结果相关联。
总体而言，在研究期间，23789名符合条件的患者中有26.7%接受了该检测。65岁及以上的女性接受检测的可能性远低于50岁以下的女性（15.1%对41.4%，p<0.001）。黑人女性接受ODX检测进行GEP的可能性略低于非西班牙裔白人女性，而亚洲女性略高于非西班牙裔白人女性（分别为22.2%、28.9%对26.9%，p<0.001）。居住在社会经济地位较低普查区的患者检测使用率最低（8.9%），且随着社会经济地位类别升高，比例增加。有医疗补助健康保险的女性接受检测的可能性低于其他女性（17.7%对27.5%，p<0.001）。辅助化疗（ACT）的接受与ODX复发评分相关，尽管复发评分显示有高获益的患者中只有63%接受了ACT。未接受检测的患者中有15%接受了ACT。
在2008年至2010年这3年期间，加利福尼亚州近四分之三符合条件的乳腺癌患者未进行GEP。因此，很可能许多女性不必要地接受了ACT并遭受了相关的发病率。此外，一些本可从ACT中获益最大的高危女性未被识别出来。
