Department of Breast Surgery, Norfolk and Norwich University Hospital Trust, Norwich, UK.
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cancer Rep (Hoboken). 2022 Aug;5(8):e1546. doi: 10.1002/cnr2.1546. Epub 2021 Oct 19.
Oncotype DX testing has reduced the use of adjuvant chemotherapy in node-negative early breast cancer but less is known about its impact in node positive patients.
This study aimed to investigate the impact of Oncotype DX gene assay testing on the decision to offer adjuvant chemotherapy in oestrogen positive, human epidermal growth factor receptor 2 negative, 1-3 lymph node positive patients.
Retrospective review of all node positive patients who underwent Oncotype DX testing at a single centre. Clinicopathological data, as well as estimated survival benefit data (from the PREDICT tool), was evaluated by a multidisciplinary group of surgeons and oncologists. Treatment decisions based on clinicopathological data were compared to recurrence scores (RS). A cut off RS > 30 was used to offer adjuvant chemotherapy.
The 69 patients were identified, of which 9 (13%) had an RS > 30 and assigned a high-genomic risk of recurrence. The 32 patients (46.4%) were offered adjuvant chemotherapy. Overall based on the use of the RS, the decision to offer adjuvant chemotherapy changed in 36% of patients, and ultimately 24 patients (34.7%) would have been spared chemotherapy.
Using clinicopathological data alone to make decisions regarding adjuvant chemotherapy in node positive breast cancer leads to overtreatment. Additional information on tumour biology as assessed by the Oncotype DX RS helps to select those patients who will benefit from adjuvant chemotherapy and spare patients from unnecessary chemotherapy.
Oncotype DX 检测减少了淋巴结阴性早期乳腺癌的辅助化疗应用，但对淋巴结阳性患者的影响知之甚少。
本研究旨在探讨 Oncotype DX 基因检测对雌激素阳性、人表皮生长因子受体 2 阴性、1-3 个淋巴结阳性患者提供辅助化疗的决策的影响。
对单一中心进行 Oncotype DX 检测的所有淋巴结阳性患者进行回顾性分析。临床病理数据以及通过 PREDICT 工具评估的估计生存获益数据，由外科医生和肿瘤学家组成的多学科小组进行评估。基于临床病理数据的治疗决策与复发评分（RS）进行比较。使用 RS＞30 来提供辅助化疗。
共确定了 69 例患者，其中 9 例（13%）RS＞30，提示高复发基因组风险。32 例（46.4%）患者接受了辅助化疗。总体而言，基于 RS 的使用，有 36%的患者改变了提供辅助化疗的决策，最终有 24 例（34.7%）患者可免于化疗。
单独使用临床病理数据来决定淋巴结阳性乳腺癌的辅助化疗会导致过度治疗。Oncotype DX RS 评估的肿瘤生物学的其他信息有助于选择那些将受益于辅助化疗的患者，并使患者免受不必要的化疗。
