Licata Luca, Viale Giulia, Giuliano Mario, Curigliano Giuseppe, Chavez-MacGregor Mariana, Foldi Julia, Oke Oluchi, Collins Joseph, Del Mastro Lucia, Puglisi Fabio, Montemurro Filippo, Vernieri Claudio, Gerratana Lorenzo, Giordano Sara, Rognone Alessia, Sica Lorenzo, Gentilini Oreste Davide, Cascinu Stefano, Pusztai Lajos, Giordano Antonio, Criscitiello Carmen, Bianchini Giampaolo
Department of Medical Oncology, San Raffaele Hospital, Milan, Italy.
School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.
NPJ Breast Cancer. 2023 Jun 8;9(1):51. doi: 10.1038/s41523-023-00559-6.
Adjuvant chemotherapy recommendations for ER+/HER2- early-stage breast cancers (eBC) involve integrating prognostic and predictive information which rely on physician judgment; this can lead to discordant recommendations. In this study we aim to evaluate whether Oncotype DX improves confidence and agreement among oncologists in adjuvant chemotherapy recommendations. We randomly select 30 patients with ER+/HER2- eBC and recurrence score (RS) available from an institutional database. We ask 16 breast oncologists with varying years of clinical practice in Italy and the US to provide recommendation for the addition of chemotherapy to endocrine therapy and their degree of confidence in the recommendation twice; first, based on clinicopathologic features only (pre-RS), and then with RS result (post-RS). Pre-RS, the average rate of chemotherapy recommendation is 50.8% and is higher among junior (62% vs 44%; p < 0.001), but similar by country. Oncologists are uncertain in 39% of cases and recommendations are discordant in 27% of cases (interobserver agreement K 0.47). Post-RS, 30% of physicians change recommendation, uncertainty in recommendation decreases to 5.6%, and discordance decreases to 7% (interobserver agreement K 0.85). Interpretation of clinicopathologic features alone to recommend adjuvant chemotherapy results in 1 out of 4 discordant recommendations and relatively high physician uncertainty. Oncotype DX results decrease discordancy to 1 out of 15, and reduce physician uncertainty. Genomic assay results reduce subjectivity in adjuvant chemotherapy recommendations for ER +/HER2- eBC.
雌激素受体阳性/人表皮生长因子受体2阴性早期乳腺癌（eBC）的辅助化疗建议涉及整合依赖医生判断的预后和预测信息；这可能导致不一致的建议。在本研究中，我们旨在评估21基因检测（Oncotype DX）是否能提高肿瘤学家在辅助化疗建议方面的信心和一致性。我们从一个机构数据库中随机选择30例有复发评分（RS）的雌激素受体阳性/人表皮生长因子受体2阴性eBC患者。我们邀请了16位在意大利和美国有不同临床实践年限的乳腺肿瘤学家，两次提供关于在内分泌治疗基础上加用化疗的建议及其对该建议的信心程度；首先，仅基于临床病理特征（RS前），然后结合RS结果（RS后）。RS前，化疗建议的平均比例为50.8%，在初级医生中更高（62%对44%；p < 0.001），但按国家划分相似。肿瘤学家在39%的病例中不确定，建议不一致的病例占27%（观察者间一致性K 0.47）。RS后，30%的医生改变建议，建议的不确定性降至5.6%，不一致性降至7%（观察者间一致性K 0.85）。仅根据临床病理特征来推荐辅助化疗会导致四分之一的建议不一致，且医生的不确定性相对较高。21基因检测结果使不一致性降至十五分之一，并降低了医生的不确定性。基因组检测结果降低了雌激素受体阳性/人表皮生长因子受体2阴性eBC辅助化疗建议中的主观性。
