Eastern Ontario Regional Laboratory, Department of Pathology and Laboratory Medicine, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
Clin Breast Cancer. 2020 Feb;20(1):61-67. doi: 10.1016/j.clbc.2019.07.006. Epub 2019 Aug 22.
Indiscriminate ordering of Oncotype DX (ODX) is expensive and of poor value to patients, physicians, and health care providers. The 3 Magee equations, Gage Algorithm, and University of Tennessee predictive algorithm all use standard clinicopathologic data to provide surrogate ODX scores. In this hypothesis-generating study, we evaluated whether these prognostic scores could be used to identify patients unlikely to benefit from additional ODX testing.
Retrospective data was collected from 302 patients with invasive ductal breast cancer and available ODX scores. Additional data was available for: Magee equations 1 (212 patients), 2 (299 patients), 3 (212 patients), Gage Algorithm (299 patients), and University of Tennessee predictive algorithm (286 patients). ODX scores were banded according to the TAILORx results.
Correlation with ODX scores was between 0.7 and 0.8 (Gage), 0.8 and 0.9 (Magee 2, University of Tennessee predictive algorithm), and > 0.9 (Magee 1 and 3). Magee 3 was the most robust and is proposed as a screening tool: for patients aged ≤ 50 years, ODX testing would be not required if the Magee 3 score was < 14 or ≥ 20; for those aged > 50 years, ODX would not be required if the Magee 3 score was < 18 or ≥ 26. Using these cut-offs, 110 (51.9%) of 212 patients would be deemed as not requiring ODX testing, and 109 (99.1%) of110 patients would be appropriately managed.
Use of all formulae, and the Magee 3 equation in particular, are proposed as possible screening tools for ODX testing, resulting in significantly reduced frequency of ODX testing. This requires validation in other populations.
盲目开具 Oncotype DX（ODX）检测既昂贵又对患者、医生和医疗保健提供者无益。三个 Magee 方程、Gage 算法和田纳西大学预测算法均使用标准临床病理数据提供替代 ODX 评分。在这项探索性研究中，我们评估了这些预后评分是否可用于识别不太可能从额外 ODX 检测中获益的患者。
回顾性收集了 302 例浸润性导管乳腺癌患者的临床资料和可用的 ODX 评分。另外还获得了 Magee 方程 1（212 例患者）、2（299 例患者）、3（212 例患者）、Gage 算法（299 例患者）和田纳西大学预测算法（286 例患者）的数据。根据 TAILORx 结果对 ODX 评分进行分组。
与 ODX 评分的相关性在 0.7 到 0.8（Gage）、0.8 到 0.9（Magee 2、田纳西大学预测算法）和>0.9（Magee 1 和 3）之间。Magee 3 是最稳健的，可作为一种筛选工具：对于年龄≤50 岁的患者，如果 Magee 3 评分<14 或≥20，则无需进行 ODX 检测；对于年龄>50 岁的患者，如果 Magee 3 评分<18 或≥26，则无需进行 ODX 检测。使用这些临界值，212 例患者中有 110 例（51.9%）被认为无需进行 ODX 检测，110 例患者中的 109 例（99.1%）得到了恰当的管理。
建议使用所有公式，特别是 Magee 3 方程，作为 ODX 检测的可能筛选工具，从而显著降低 ODX 检测的频率。这需要在其他人群中进行验证。
