S P Somashekhar, Patil Shekar, Kumar Rajeev, Prasad Krishna, Vijay Devanhalli Govinda, Singh Malhotra Mandeep, Khandelwal Rohan, Bapna Ajay, Udupa Karthik S, Doval D C, C B Avinash, Shankar Kiran, Pai Ananth, Agrawal Chaturbhuj, Thippeswamy Ravi
Surgical Oncology, Aster CMI Hospital, Bangalore, IND.
Medical Oncology, Healthcare Global Enterprises (HCG) Cancer Center, Bangalore, IND.
Cureus. 2024 Dec 12;16(12):e75622. doi: 10.7759/cureus.75622. eCollection 2024 Dec.
Background Clinicians use prognostic biomarker/multi-gene-based tests for predicting recurrence in hormone receptor-positive/HER2-negative (HR+/HER2-) early-stage breast cancer (EBC). CanAssist Beast (CAB) uses the expression of five protein biomarkers in combination with tumor-specific parameters such as tumor size, histopathological grade, and lymph node status to predict the risk of distant recurrence within five years of diagnosis for patients with HR+/HER2-, EBC. The current study aimed to evaluate the impact of prognostic tests on adjuvant chemotherapy decisions by assessing the agreement between clinical and CAB risk stratification as low-risk (LR) or high-risk (HR) for distant recurrence. Methods The primary study group included 300 patients with HR+/HER2-, EBC diagnosed between 2016 and 2021. The clinical risk assessment and recommended treatment plan were captured before and after receiving the results for CAB. The risk stratification of patients into CAB LR and HR was obtained. Finally, compliance with CAB was analyzed by assessing the concordance of treatment prescribed with the CAB risk category. Results Before performing the CanAssist Breast test, patients were stratified based on clinicopathological features, with 52% of patients as LR, 21% as HR, and 27% of patients distributed as uncertain/intermediate risk (IR) category. CAB re-stratified the same cohort of patients, 67% as LR and 33% as HR, which was 15% higher than that of clinical LR assessment. The clinical IR category was re-stratified by CAB as 51% LR and 49% HR. Changes in treatment recommendations were seen in both clinical HR and clinical LR groups, which were 87% and 85%, respectively. Conclusions CAB has a significant impact on chemotherapy decisions. CAB provides definite treatment recommendations for patients with clinical intermediate risk. Overall, CAB has changed treatment recommendations in 23% of the cohort and for 88% of clinical IR patients helped physicians make a treatment decision.
背景 临床医生使用基于预后生物标志物/多基因的检测来预测激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）早期乳腺癌（EBC）的复发情况。CanAssist Beast（CAB）通过结合五种蛋白质生物标志物的表达以及肿瘤大小、组织病理学分级和淋巴结状态等肿瘤特异性参数，来预测HR+/HER2-、EBC患者在诊断后五年内远处复发的风险。本研究旨在通过评估临床与CAB对远处复发的低风险（LR）或高风险（HR）分层之间的一致性，来评估预后检测对辅助化疗决策的影响。方法 主要研究组包括2016年至2021年期间诊断为HR+/HER2-、EBC的300例患者。在获得CAB结果前后记录临床风险评估和推荐的治疗方案。将患者分为CAB LR和HR风险分层。最后，通过评估所开治疗与CAB风险类别之间的一致性来分析对CAB的依从性。结果 在进行CanAssist Breast检测之前，根据临床病理特征对患者进行分层，52%的患者为LR，21%为HR，27%的患者分布为不确定/中度风险（IR）类别。CAB对同一组患者重新分层，67%为LR，33%为HR，比临床LR评估高15%。临床IR类别经CAB重新分层后，51%为LR，49%为HR。临床HR组和临床LR组的治疗建议均有变化，分别为87%和85%。结论 CAB对化疗决策有显著影响。CAB为临床中度风险患者提供了明确的治疗建议。总体而言，CAB在23%的队列中改变了治疗建议，对于88%的临床IR患者，帮助医生做出了治疗决策。
