Gagnet Simon, Diorio Caroline, Provencher Louise, Mbuya-Bienge Cynthia, Lapointe Julie, Morin Claudya, Lemieux Julie, Nabi Hermann
Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada.
Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada.
J Pers Med. 2021 Aug 28;11(9):858. doi: 10.3390/jpm11090858.
Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such as a high cost and a long turnaround time to get results, which may lead to disparities in access. We aim to identify clinicopathological factors associated with ODX RS in women with early-stage BC. We conducted a retrospective cohort study of women identified in the medical database of the Deschênes-Fabia Breast Disease Center of Quebec City University, Canada. Our sample consists of 425 women diagnosed with early-stage BC who have obtained an ODX RS between January 2011 and April 2015. The ODX RS has been categorized into three levels as originally defined: low (0-17), intermediate (18-30), and high (>30). The mean RS was 17.8 (SD = 9.2). Univariate analyses and multinomial logistic regressions were performed to identify factors associated with intermediate and high RS compared with low RS. A total of 237 (55.8%) patients had low RS, 148 (34.8%) had intermediate RS, and 40 (9.4%) had high RS. Women with progesterone receptor (PR)-negative (ORs ranging from 3.51 to 10.34) and histologic grade II (ORs ranging from 3.16 to 23.04) tumors were consistently more likely to have intermediate or high RS than low RS. Similar patterns of associations were observed when the RS was categorised using redefined thresholds from (i.e., from the TAILORx study or dichotomized). This study provides evidence suggesting that histologic grade and PR status are predictive factors for intermediate or high RS in women with early-stage BC. If these results are confirmed in future studies, considering these clinicopathological factors could spare women the need to get such a test before the beginning of a possible adjuvant therapy. This option could be considered in settings where the cost of testing is an issue.
诸如Oncotype DX（ODX）21基因复发评分（RS）检测等基因表达谱检测在临床实践中越来越多地用于预测早期乳腺癌（BC）的复发风险并辅助治疗方案的制定。然而，该检测存在一些缺点，如成本高、获得结果的周转时间长，这可能导致检测机会的不平等。我们旨在确定早期BC女性中与ODX RS相关的临床病理因素。我们对加拿大魁北克市大学Deschênes-Fabia乳腺疾病中心医学数据库中识别出的女性进行了一项回顾性队列研究。我们的样本包括425名在2011年1月至2015年4月期间获得ODX RS的早期BC诊断女性。ODX RS已按照最初定义分为三个水平：低（0 - 17）、中（18 - 30）和高（>30）。平均RS为17.8（标准差 = 9.2）。进行单因素分析和多项逻辑回归以确定与低RS相比，中、高RS相关的因素。共有237名（55.8%）患者RS低，148名（34.8%）患者RS中，40名（9.4%）患者RS高。孕激素受体（PR）阴性（比值比范围为3.51至10.34）和组织学2级（比值比范围为3.16至23.04）肿瘤的女性始终比RS低的女性更有可能具有中或高RS。当使用重新定义的阈值（即来自TAILORx研究或二分法）对RS进行分类时，观察到类似的关联模式。本研究提供的证据表明，组织学分级和PR状态是早期BC女性中、高RS的预测因素。如果这些结果在未来研究中得到证实，在可能的辅助治疗开始前考虑这些临床病理因素可以使女性无需进行此类检测。在检测成本成为问题的情况下，可以考虑这一选择。
