Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Biostatistics University of Pittsburgh, Pittsburgh, PA, USA.
Mod Pathol. 2017 Aug;30(8):1078-1085. doi: 10.1038/modpathol.2017.41. Epub 2017 May 26.
Magee Equations were derived as an inexpensive, rapid alternative to Oncotype DX. The Magee Equation 3 utilizes immunohistochemical and FISH data for estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki-67 for its calculation (24.30812+ERIHC × (-0.02177)+PRIHC × (-0.02884)+(0 for HER2 negative, 1.46495 for equivocal, 12.75525 for HER2 positive)+Ki-67 × 0.18649). We hypothesize that Magee Equation 3 scores from pre-therapy core biopsy can predict response to neoadjuvant systemic chemotherapy. A prospectively-maintained database of patients who received neoadjuvant systemic therapy from 2010 to 2014 at a single institution was retrospectively reviewed. Pathologic complete response was defined as absence of invasive tumor in the breast and regional lymph nodes. Of the 614 cases, tumors with missing immunohistochemical results and those that were ER negative or HER2 positive were excluded. This resulted in 237 ER positive, HER2 negative/equivocal tumors that formed the basis of this study. Magee Equation 3 scores were divided into 3 categories similar to Oncotype DX, ie, 0 to <18 (low), 18 to <31 (intermediate), and 31 or higher (high) scores. The pathologic complete response rate for low, intermediate and high Magee Equation 3 scores was 0%, 4%, and 36%, respectively. Patients with high Magee Equation 3 scores were 13 times more likely to achieve pathologic complete response compared to those with Magee Equation 3 scores less than 31 (95% CI 5.09-32.87, P<0.0001). For patients that did not achieve pathologic complete response, high Magee Equation 3 correlated with higher recurrence rate, with the majority occurring in patients with positive lymph nodes in the resection specimen. Magee Equation 3 score ≥31 predicts pathologic complete response in the neoadjuvant setting and for tumor recurrence, when pathologic complete response is not achieved. These results show the utility of Magee Equation 3 in predicting patients who will benefit from chemotherapy but warrant prospective multi-institutional validation.
Magee 方程是作为一种廉价、快速的替代 Oncotype DX 的方法而推导出来的。Magee 方程 3 利用雌激素受体（ER）、孕激素受体（PR）、HER2 和 Ki-67 的免疫组化和 FISH 数据进行计算（24.30812+ERIHC×（-0.02177）+PRIHC×（-0.02884）+（HER2 阴性为 0，HER2 不确定为 1.46495，HER2 阳性为 12.75525）+Ki-67×0.18649）。我们假设术前核心活检的 Magee 方程 3 评分可以预测新辅助全身化疗的反应。回顾性分析了 2010 年至 2014 年在一家单机构接受新辅助全身治疗的患者的前瞻性维护数据库。病理完全缓解定义为乳腺和区域淋巴结中无浸润性肿瘤。在 614 例病例中，排除了免疫组化结果缺失的肿瘤和 ER 阴性或 HER2 阳性的肿瘤。这导致了 237 例 ER 阳性、HER2 阴性/不确定的肿瘤，这些肿瘤构成了本研究的基础。Magee 方程 3 评分分为 3 类，类似于 Oncotype DX，即 0 至<18（低）、18 至<31（中）和 31 或更高（高）评分。低、中、高 Magee 方程 3 评分的病理完全缓解率分别为 0%、4%和 36%。与 Magee 方程 3 评分<31 的患者相比，Magee 方程 3 评分高的患者病理完全缓解的可能性高 13 倍（95%CI 5.09-32.87，P<0.0001）。对于未达到病理完全缓解的患者，高 Magee 方程 3 与更高的复发率相关，大部分复发发生在切除标本中有阳性淋巴结的患者中。Magee 方程 3 评分≥31 预测新辅助治疗和病理完全缓解时肿瘤复发，当未达到病理完全缓解时。这些结果表明，Magee 方程 3 在预测将从化疗中获益的患者方面具有实用性，但需要前瞻性的多机构验证。
