Dept of Clinical Hematology, Mahatma Gandhi Medical College Hospital, Jaipur, 302023, India.
HCG Cancer Hospital, Bengaluru, 560027, India.
BMC Cancer. 2023 Jul 31;23(1):714. doi: 10.1186/s12885-023-11121-9.
Precise prognostication is the key to optimum and effective treatment planning for early-stage hormone receptor (HR) positive, HER2/neu negative breast cancer patients. Differences in the breast cancer incidence and tumor anatomical features at diagnosis, pharmacogenomics data between Western and Indian women along with the vast diversity in the economic status and differences in insurance policies of these regions; suggest recommendations put forward for Western women might not be applicable to Indian/Asian women. Opinions from oncologists through a voting survey on various prognostic factors/tools to be considered for planning adjuvant therapy are consolidated in this report for the benefit of oncologists of the sub-continent, SAARC and Asia's LMIC (low and middle-income countries).
A three-phase DELPHI survey was conducted to collect opinions on prognostic factors considered for planning adjuvant therapy in early-stage HR+/HER2/neu negative breast cancer patients. A panel of 25 oncologists with expertise in breast cancer participated in the survey conducted in 2021. The experts provided opinions as 'agree' or disagree' or 'not sure' in phases-1 and 2 which were conducted virtually; in the final phase-3, all the panel experts met in person and concluded the survey.
Opinions on 41 statements related to prognostic factors/tools and their implications in planning adjuvant endocrine/chemotherapy were collected. All the statements were supported by the latest data from the clinical trials (prospective/retrospective). The statements with opinions of consensus less than 66% were disseminated in phase-2, and later in phase-3 with supporting literature. In phase-3, all the opinions from panelists were consolidated and guidelines were framed.
This consensus guideline will assist oncologists of India, SAARC and LMIC countries in informed clinical decision-making on adjuvant treatment in early HR+/HER2/neu negative breast cancer patients.
对于早期激素受体（HR）阳性、HER2/neu 阴性乳腺癌患者，准确的预后预测是优化和有效治疗计划的关键。西方和印度女性的乳腺癌发病率和肿瘤解剖特征存在差异，药物基因组学数据也存在差异，再加上这些地区的经济状况和保险政策存在巨大差异，这表明针对西方女性提出的建议可能不适用于印度/亚洲女性。本报告综合了肿瘤学家通过投票调查对各种预后因素/工具的意见，这些因素/工具被认为对规划辅助治疗有用，目的是为该次区域、南盟和亚洲中低收入国家（LMIC）的肿瘤学家提供参考。
进行了三阶段 DELPHI 调查，以收集有关早期 HR+/HER2/neu 阴性乳腺癌患者辅助治疗规划中考虑的预后因素的意见。一个由 25 名具有乳腺癌专业知识的肿瘤学家组成的小组参与了 2021 年进行的调查。专家们在第一阶段和第二阶段通过虚拟方式以“同意”、“不同意”或“不确定”的形式提供意见；在最后阶段-3 中，所有小组专家都亲自会面并完成了调查。
收集了与预后因素/工具及其对规划辅助内分泌/化疗的影响相关的 41 项声明的意见。所有声明都得到了临床试验（前瞻性/回顾性）的最新数据支持。在第二阶段，将共识意见小于 66%的声明进行了传播，之后在第三阶段结合文献进行了传播。在第三阶段，对小组成员的所有意见进行了整合，并制定了指南。
本共识指南将有助于印度、南盟和 LMIC 国家的肿瘤学家在早期 HR+/HER2/neu 阴性乳腺癌患者的辅助治疗中做出明智的临床决策。
