Schreuder K, Kuijer A, Rutgers E J Th, Smorenburg C H, van Dalen Th, Siesling S
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Cancer. 2017 Oct;84:270-277. doi: 10.1016/j.ejca.2017.07.042. Epub 2017 Aug 24.
In Dutch guidelines, gene expression profiles (GEP) are indicated in estrogen receptor positive early breast cancer patients in whom benefit of chemotherapy (CT) is uncertain based on traditional prognostic factors alone. Aim of the present study is to assess the use and impact of GEP on administration of adjuvant CT in breast cancer patients who have according to national guidelines a clear indication to either use or withhold adjuvant chemotherapy (clinical high or low risk).
Clinical low- and high-risk patients, according to Dutch breast cancer guidelines, diagnosed between 2011 and 2014 were selected from the Netherlands Cancer Registry. Influence of GEP use and GEP test result on CT administration was assessed with logistic regression.
Overall, 26,425 patients were identified; 4.8% of patients with clinical low risk (444/9354), 7.5% of the patients with a clinical high risk (1281/17,071) received a GEP. GEP use was associated with significantly increased odds of CT administration in clinical low-risk patients (OR = 2.12 95% CI: 1.44-3.11). In clinical high-risk patients, GEP use was associated with a decreased frequency of CT administration (OR = 0.55, 95% CI: 0.48-0.63). Adherence to the GEP result was higher in clinical high-risk patients with a discordant GEP result as compared to clinical low-risk patients with a discordant GEP result: 71.7% vs. 52.2%, respectively.
GEP is frequently used outside the indicated area and significantly influenced the administration of adjuvant CT, although adherence to the test result was limited.
在荷兰指南中，基因表达谱（GEP）适用于雌激素受体阳性的早期乳腺癌患者，这些患者仅根据传统预后因素难以确定化疗（CT）是否有益。本研究的目的是评估GEP在乳腺癌患者辅助性CT给药中的应用及影响，这些患者根据国家指南有明确的辅助化疗使用或不使用指征（临床高风险或低风险）。
从荷兰癌症登记处选取2011年至2014年间根据荷兰乳腺癌指南诊断的临床低风险和高风险患者。通过逻辑回归评估GEP使用和GEP检测结果对CT给药的影响。
总体而言，共识别出26425例患者；临床低风险患者中有4.8%（444/9354）、临床高风险患者中有7.5%（1281/17071）接受了GEP检测。在临床低风险患者中，使用GEP与CT给药几率显著增加相关（OR = 2.12，95% CI：1.44 - 3.11）。在临床高风险患者中，使用GEP与CT给药频率降低相关（OR = 0.55，95% CI：0.48 - 0.63）。与GEP结果不一致的临床低风险患者相比，GEP结果不一致的临床高风险患者对GEP结果的依从性更高：分别为71.7%和52.2%。
GEP常在指定范围外使用，并对辅助性CT给药有显著影响，尽管对检测结果的依从性有限。
