Rath Michelle G, Uhlmann Lorenz, Fiedler Marita, Heil Joerg, Golatta Michael, Dinkic Christine, Hennigs Andre, Schott Sarah, Ernst Veronika, Koch Thorsten, Sohn Christof, Brucker Cosima, Rom Joachim
Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Department of Gynecology and Obstetrics, Paracelsus Medical University, Prof.-Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany.
Arch Gynecol Obstet. 2018 Feb;297(2):443-447. doi: 10.1007/s00404-017-4618-z. Epub 2017 Dec 13.
Breast cancer is the leading cause of death from cancer in women and the most common cancer in the world [1]. To date, many patients with estrogen-receptor-positive (ER+) breast cancer are overtreated with chemotherapy when the rationale for adjuvant chemotherapy is based on clinicopathologic parameters. Different studies were able to demonstrate that a 21-gene expression assay (Oncotype DX Genomic Health, Redwood City, CA) can predict the benefit from adjuvant chemotherapy in ER+ breast cancers [2, 3] and provide additional prognostic information independent of clinicopathological features [4].
Data from all patients with ER+ Her2neu- breast cancer undergoing Oncotype DX testing between 2011 and 2014 at a tertiary referral center in Germany were analyzed. Oncotype DX was performed in 69 cases, in 2 cases data were missing and in 3 cases Oncotype DX could not be performed by the company. The results showed a low risk in 39 cases, an intermediate risk in 22 cases and a high risk in 3 cases. Based on Oncotype results, treatment recommendations were changed in 39 of 64 patients (61%). Before Oncotype DX testing, chemotherapy was recommended in 67 patients, afterwards only in 25 patients. Data from 44 of 67 patients were matched to controls for stage, tumor grade, menopausal and hormone receptor status. Within a mean observation time of 19.7 months, cancer recurrence was observed in two patients.
Oncotype DX testing can be recommended for risk-tailored chemotherapy. Results should be validated in larger prospective studies.
乳腺癌是女性癌症死亡的主要原因，也是全球最常见的癌症[1]。迄今为止，许多雌激素受体阳性（ER+）乳腺癌患者在辅助化疗的依据基于临床病理参数时，接受了过度化疗。不同的研究表明，21基因表达检测（Oncotype DX，Genomic Health公司，加利福尼亚州红木城）可以预测ER+乳腺癌辅助化疗的获益[2,3]，并提供独立于临床病理特征的额外预后信息[4]。
分析了2011年至2014年期间在德国一家三级转诊中心接受Oncotype DX检测的所有ER+ Her2neu-乳腺癌患者的数据。共69例患者进行了Oncotype DX检测，2例数据缺失，3例公司无法进行Oncotype DX检测。结果显示，39例为低风险，22例为中度风险，3例为高风险。根据Oncotype检测结果，64例患者中有39例（61%）的治疗建议发生了改变。在进行Oncotype DX检测之前，67例患者被建议进行化疗，之后只有25例。67例患者中的44例数据与分期、肿瘤分级、绝经和激素受体状态的对照组进行了匹配。在平均19.7个月的观察期内，2例患者出现癌症复发。
Oncotype DX检测可用于风险个体化化疗。结果应在更大规模的前瞻性研究中得到验证。
