Department of Surgery, University of Chicago, Chicago, IL, USA.
Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Ann Surg Oncol. 2019 Oct;26(10):3232-3239. doi: 10.1245/s10434-019-07555-w. Epub 2019 Jul 24.
The utilization of OncotypeDx in the setting of neoadjuvant chemotherapy (NCT) is not well defined. The objective of this study was to determine what proportion of hormone receptor (HR)-positive patients undergoing NCT would not benefit from chemotherapy based on OncotypeDx recurrence scores (RS) and predictors of a high RS as defined by the TAILORx trial.
The National Cancer Data Base was used to identify patients with unilateral clinical stage I-III HR+/Her2- breast cancer who had an OncotypeDx score and who had undergone NCT. Patients undergoing adjuvant chemotherapy were used as a comparison group.
Of 307,666 patients, 41.8% had testing with OncotypeDx. Of these, 76.6% had no chemotherapy, 22.3% adjuvant chemotherapy, and 1.1% NCT. OncotypeDx testing in NCT patients increased from 4.9% in 2010 to 8.2% in 2015. Of NCT patients with OncotypeDx testing, 11.6% had RS < 11, 44.4% RS 11-25, and 43.9% RS > 25. In patients age ≤ 50 years, 14.5% had RS < 11, 12.4% RS 11-15, 31.4% RS 16-25, and 41.7% RS > 25. Predictors of RS > 25 on multivariable analysis included grade 3 tumors (odds ratio [OR] 3.83) and PR-negative tumors (OR 5.26) but not clinical T or N stage (p > 0.05).
More than half of patients with OncotypeDx testing are being overtreated with NCT, and a third of younger patients are being overtreated. Predictors of a high RS are reliably available at core biopsy, suggesting an application of OncotypeDx in determining the need for NCT for some HR-positive breast cancers.
在新辅助化疗（NCT）中使用 OncotypeDx 的应用尚未明确。本研究旨在确定根据 TAILORx 试验确定的高 RS 预测因素和 OncotypeDx 复发评分（RS），有多少 HR 阳性患者在接受 NCT 后不会受益于化疗。
国家癌症数据库用于确定单侧临床 I-III 期 HR+/Her2-乳腺癌患者中进行了 OncotypeDx 评分且接受 NCT 的患者。接受辅助化疗的患者作为比较组。
在 307666 例患者中，41.8%接受了 OncotypeDx 检测。其中，76.6%未接受化疗，22.3%接受辅助化疗，1.1%接受 NCT。NCT 患者的 OncotypeDx 检测从 2010 年的 4.9%增加到 2015 年的 8.2%。在接受 OncotypeDx 检测的 NCT 患者中，11.6%的 RS<11，44.4%的 RS 为 11-25，43.9%的 RS>25。在年龄≤50 岁的患者中，14.5%的 RS<11，12.4%的 RS 为 11-15，31.4%的 RS 为 16-25，41.7%的 RS>25。多变量分析的 RS>25 的预测因素包括 3 级肿瘤（比值比 [OR] 3.83）和 PR 阴性肿瘤（OR 5.26），但临床 T 或 N 分期则无此预测作用（p>0.05）。
接受 OncotypeDx 检测的患者中有一半以上接受 NCT 过度治疗，三分之一的年轻患者接受过度治疗。高 RS 的预测因素可在核心活检中可靠获得，这表明 OncotypeDx 可应用于确定某些 HR 阳性乳腺癌是否需要 NCT。
