Thibodeau Stephane, Voutsadakis Ioannis A
Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada; Algoma District Cancer Program, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada.
Hematol Oncol Stem Cell Ther. 2019 Jun;12(2):89-96. doi: 10.1016/j.hemonc.2019.02.001. Epub 2019 Feb 19.
OBJECTIVE/BACKGROUND: The Oncotype Dx test is a genomic test currently used in clinical practice to predict the risk of disease recurrence in estrogen receptor (ER)-positive, HER2-negative breast cancer patients with axillary lymph node-negative or micrometastatic disease. The test is one of several similar genomically based tests available. Although it has a good predictive value, it is expensive and thus constitutes a significant financial burden for health systems. Thus, several attempts have been made to devise low-cost tools that could predict the recurrence score derived from the genomic evaluation using easily obtainable clinical parameters.
Two previously proposed predictive tools were evaluated in a cohort of 201 patients that had undergone the Oncotype Dx test for their efficacy in predicting the Oncotype Dx Recurrence Score (RS). A simple predictor, named GR-PR, based on two available pathologic parameters, grade and progesterone receptor status was devised and also evaluated.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of all three tools were compared and found to be similar for all cutoff points of Oncotype Dx RS. The accuracy of GR-PR was comparable to the best performing of the two other prediction tools for all four cutoff points.
The simple GR-PR predictor proposed in this study seems to be at least as accurate as more complex tools and should be the preferred tool for the prediction of Oncotype Dx RS from clinicopathologic parameters when the Oncotype Dx test is not available.
目的/背景：Oncotype Dx检测是一种基因组检测，目前用于临床实践，以预测雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性且腋窝淋巴结阴性或微转移的乳腺癌患者疾病复发的风险。该检测是几种类似的基于基因组的检测方法之一。尽管它具有良好的预测价值，但价格昂贵，因此给卫生系统带来了巨大的经济负担。因此，人们多次尝试设计低成本工具，这些工具可以使用易于获得的临床参数来预测从基因组评估得出的复发评分。
在一组201例接受Oncotype Dx检测的患者中评估了两种先前提出的预测工具，以评估它们预测Oncotype Dx复发评分（RS）的有效性。设计了一种基于两个可用病理参数（分级和孕激素受体状态）的简单预测指标，称为GR-PR，并对其进行了评估。
比较了所有三种工具的敏感性、特异性、阳性预测值、阴性预测值和准确性，发现对于Oncotype Dx RS的所有截断点，它们都相似。对于所有四个截断点，GR-PR的准确性与其他两种预测工具中表现最佳的相当。
本研究中提出的简单GR-PR预测指标似乎至少与更复杂的工具一样准确，并且当无法进行Oncotype Dx检测时，它应该是从临床病理参数预测Oncotype Dx RS的首选工具。
