Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
Division of Gastrointestinal Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA.
Med Oncol. 2022 Feb 12;39(5):59. doi: 10.1007/s12032-022-01660-9.
Although studies have demonstrated the 12-gene Oncotype DX Colon Recurrence Score's (RS) validity in predicting recurrence and influence on physician-patient decision-making, its discriminatory power and inability to predict response to treatment make its clinical impact uncertain. We sought to evaluate the influence of RS in the decision to offer adjuvant chemotherapy after resection of stage IIa colon cancer. A review of patients with stage IIa colon cancer who obtained the RS at a tertiary academic medical center was conducted. The main study outcome was decision to start adjuvant chemotherapy. The association between RS and the decision to obtain adjuvant chemotherapy was evaluated utilizing the Wilcoxon rank-sum test and area under the receiver operating characteristic curve. 52 of 105 patients with stage IIa colon cancer underwent RS testing. Overall, seven of 52 patients (13%) received adjuvant chemotherapy. 34 (65%) patients obtained the RS test despite having multiple other recurrence risk factors. There were no significant associations between any patient/tumor characteristic and RS score (all p > 0.08) or starting adjuvant chemotherapy (all p > 0.15). On multivariable analysis, there was no significant effect of RS on the odds of undergoing chemotherapy (OR 1.07, 95% CI 0.98-1.19; p = 0.14). There was no clear association between RS and starting adjuvant chemotherapy (AUC 0.64, 95% CI 0.36-0.91; p = 0.25). RS was not associated with the decision to start adjuvant chemotherapy. Given its lack of association with clinical decision-making and inability to predict clinical outcome, our data suggest the RS should not be obtained in patients with stage IIa colon cancer.
尽管研究已经证明了 12 基因 Oncotype DX 结肠癌复发评分（RS）在预测复发和影响医患决策方面的有效性，但它的区分能力和无法预测治疗反应使其临床影响不确定。我们试图评估 RS 在 IIa 期结肠癌切除术后提供辅助化疗决策中的影响。对在一家三级学术医疗中心获得 RS 的 IIa 期结肠癌患者进行了回顾。主要研究结果是决定开始辅助化疗。利用 Wilcoxon 秩和检验和受试者工作特征曲线下面积评估 RS 与获得辅助化疗决定之间的关系。在 105 例 IIa 期结肠癌患者中，有 52 例进行了 RS 检测。总体而言，52 例患者中有 7 例（13%）接受了辅助化疗。尽管有多个其他复发风险因素，仍有 34 例（65%）患者进行了 RS 检测。没有任何患者/肿瘤特征与 RS 评分（所有 p>0.08）或开始辅助化疗（所有 p>0.15）之间存在显著关联。多变量分析显示，RS 对接受化疗的几率没有显著影响（OR 1.07，95%CI 0.98-1.19；p=0.14）。RS 与开始辅助化疗之间没有明显关联（AUC 0.64，95%CI 0.36-0.91；p=0.25）。RS 与开始辅助化疗的决定无关。鉴于其与临床决策无明显关联且无法预测临床结局，我们的数据表明，不应在 IIa 期结肠癌患者中获取 RS。
