Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY.
Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY.
J Am Coll Surg. 2018 Apr;226(4):406-412.e1. doi: 10.1016/j.jamcollsurg.2017.12.043. Epub 2018 Jan 31.
A growing body of evidence supports the use of multigene signature panels (MSPs) in predicting recurrence risk in patients with invasive breast cancer. This study aimed to evaluate trends in MSP use over time and the effect of MSPs on administration of postoperative chemotherapy.
The National Cancer Database was queried for all women with invasive breast cancer who underwent resection between 2011 and 2014 and had information about performance of an MSP, hormone receptor status, and receipt of chemotherapy. Multigene signature panel use over time was evaluated, and patterns of use of Oncotype DX (ODX) and MammaPrint (MP) were compared.
In a total of 476,128 patients, an MSP was obtained in 153,782 (30.2%). Multigene signature panel use increased over time and was associated with a decreased rate of chemotherapy administration (24.6% MSP vs 37.2% no MSP; p < 0.001). Oncotype DX remained the most common MSP used throughout the study period. Oncotype DX was used more commonly in stage I disease than MP, and MP was used more commonly in stage II and III disease. MammaPrint was more commonly used in hormone receptor-negative patients, human epidermal growth factor receptor 2-positive patients, and patients with positive lymph nodes. Postoperative chemotherapy was administered to a higher proportion of patients assessed with MP than with ODX (41.3% vs 23.4%, respectively; p < 0.001).
Use of MSPs among patients with breast cancer has increased over time and is associated with a decreased use of adjuvant chemotherapy. Oncotype DX continues to be the most widely used MSP, although MP use has increased over time. Future studies are warranted to determine the optimal use of these MSPs in risk assessment and postoperative decision making.
越来越多的证据支持使用多基因标志面板（MSP）来预测浸润性乳腺癌患者的复发风险。本研究旨在评估 MSP 使用随时间的变化趋势，以及 MSP 对术后化疗的影响。
国家癌症数据库检索了 2011 年至 2014 年间接受切除术的所有浸润性乳腺癌女性患者，这些患者的信息包括 MSP 的检测、激素受体状态和化疗的使用情况。评估了 MSP 使用随时间的变化，并比较了 Oncotype DX（ODX）和 MammaPrint（MP）的使用模式。
在总共 476128 名患者中，153782 名（30.2%）获得了 MSP。MSP 的使用随着时间的推移而增加，与化疗的使用率降低有关（24.6% MSP 比 37.2% 无 MSP；p < 0.001）。ODX 一直是整个研究期间最常用的 MSP。在 I 期疾病中，ODX 的使用比 MP 更常见，而在 II 期和 III 期疾病中，MP 的使用更为常见。MP 在激素受体阴性、人类表皮生长因子受体 2 阳性和淋巴结阳性的患者中更为常见。与 ODX 相比，MP 评估后接受术后化疗的患者比例更高（分别为 41.3%和 23.4%；p < 0.001）。
乳腺癌患者 MSP 的使用随着时间的推移而增加，与辅助化疗的使用率降低有关。ODX 仍然是最广泛使用的 MSP，尽管 MP 的使用随着时间的推移而增加。需要进一步研究来确定这些 MSP 在风险评估和术后决策中的最佳使用。
