Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
PLoS One. 2023 Aug 17;18(8):e0290174. doi: 10.1371/journal.pone.0290174. eCollection 2023.
Considering prognostic and anatomic stages in early-stage premenopausal patients with breast cancer, clinicians decide on performing the multigene assay, adjuvant chemotherapy, or ovarian function suppression (OFS). This decision is also based on genetic information related to hormone receptor-positive and human epidermal growth factor receptor 2 negative results. We aimed to determine the tendency to use adjuvant therapy in clinical practice.
From April to May 2022, clinicians of the Korean Breast Cancer Society responded to a web-based survey. The survey included 62 multiple-choice questions mainly on decision-making under different pathologic conditions.
Among 92 responding clinicians, 91.3% were breast surgeons. For 35-year-old patients (pT2N0 and Ki-67 50% profile), 96.8% of clinicians selected chemotherapy, whereas 50.7% selected chemotherapy for patients with pT1N0, Ki-67 10%, and without Oncotype Dx (ODX). Only 35.6% selected chemotherapy for 47-year-old patients with the same profiles, while 84.3% and 49.1% chose chemotherapy with ODX recurrence score 21 and 16, respectively. More clinicians selected tamoxifen (TMX) plus OFS than aromatase inhibitor (AI) plus OFS for 5 years of endocrine therapy in patients with adjuvant chemotherapy regardless of genomic and clinical risks. However, for the same patients without adjuvant chemotherapy, more clinicians selected AI plus OFS. A longer duration of additional OFS and TMX was selected in patients with high clinical and genomic risks, and the duration of OFS was relatively shorter in older patients.
The decision regarding adjuvant therapy should be made considering clinical and genomic risks and age, and clinicians should consult with patients about adverse effects and compliance.
考虑到早期绝经前乳腺癌患者的预后和解剖分期，临床医生决定进行多基因检测、辅助化疗或卵巢功能抑制（OFS）。这一决策还基于与激素受体阳性和人表皮生长因子受体 2 阴性结果相关的遗传信息。我们旨在确定在临床实践中使用辅助治疗的趋势。
2022 年 4 月至 5 月，韩国乳腺癌学会的临床医生对一项基于网络的调查做出了回应。该调查包括 62 个多项选择题，主要涉及不同病理条件下的决策。
在 92 名回应的临床医生中，91.3%是乳腺外科医生。对于 35 岁的患者（pT2N0 和 Ki-67 50% 谱），96.8%的临床医生选择化疗，而 50.7%的临床医生选择化疗用于 pT1N0、Ki-67 10%、且无 Oncotype Dx（ODX）的患者。只有 35.6%的临床医生选择化疗用于具有相同特征的 47 岁患者，而 84.3%和 49.1%分别选择 ODX 复发评分 21 和 16 的患者化疗。无论基因组和临床风险如何，对于接受辅助化疗的患者，更多的临床医生选择他莫昔芬（TMX）加 OFS 而不是芳香酶抑制剂（AI）加 OFS 进行 5 年内分泌治疗。然而，对于没有接受辅助化疗的相同患者，更多的临床医生选择 AI 加 OFS。对于具有高临床和基因组风险的患者，选择了更长时间的额外 OFS 和 TMX，并且在老年患者中 OFS 的持续时间相对较短。
辅助治疗的决策应考虑临床和基因组风险以及年龄，并应与患者讨论不良反应和依从性。
