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Menopausal status does not predict Oncotype DX recurrence score. J Surg Res 2015; 198:27-33. [PMID: 26095420 DOI: 10.1016/j.jss.2015.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adjuvant treatment for early stage, estrogen receptor (ER) positive invasive breast cancer has been based on prognosticators such as menopausal status. The recurrence score (RS) from the 21-gene assay Oncotype DX (ODX) is predictive of a 10-y distant recurrence in this population but is rarely applied to premenopausal patients. The relationship between menopausal status and RS was evaluated. MATERIALS AND METHODS An institutional review board-approved retrospective review was conducted of invasive breast cancer patients with known RS. ODX eligibility was based on National Comprehensive Cancer Network guidelines or physician discretion. Perimenopausal women were classified as premenopausal for statistical analyses. Comparisons of menopausal status and RS were made using general linear regression model and the exact Wilcoxon rank-sum test. RESULTS Menopausal status was available for 575 patients (142 premenopausal, 433 postmenopausal). Median age was 46 y for premenopausal and 62 y for postmenopausal. Median invasive tumor size was 1.5 cm for both cohorts. Mastectomy rate was higher in the premenopausal group (54.8%) than postmenopausal (42%; P = 0.0001). Premenopausal women had a higher local-regional recurrence rate (2.8% versus 0%; P = 0.0384) but distant recurrence and overall survival were not statistically different (P = 0.6808). Median ER H-score was lower in premenopausal (H-score = 270) than postmenopausal women (H-score = 280; P < 0.0001). Median RS was 16 for both premenopausal (range, 0-54) and postmenopausal (range, 0-63) women. Menopausal status as a categorical variable was not predictive of RS (P-value = 0.6780). CONCLUSIONS Menopausal status has limited predictive power for distant recurrence. Therefore, menopausal status alone should not preclude performance of ODX in ER-positive, early stage breast cancer.
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Eiermann W, Rezai M, Kümmel S, Kühn T, Warm M, Friedrichs K, Schneeweiss A, Markmann S, Eggemann H, Hilfrich J, Jackisch C, Witzel I, Eidtmann H, Bachinger A, Hell S, Blohmer J. The 21-gene recurrence score assay impacts adjuvant therapy recommendations for ER-positive, node-negative and node-positive early breast cancer resulting in a risk-adapted change in chemotherapy use. Ann Oncol 2012; 24:618-24. [PMID: 23136233 PMCID: PMC3574549 DOI: 10.1093/annonc/mds512] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background We carried out a prospective clinical study to evaluate the impact of the Recurrence Score (RS) on treatment decisions in early breast cancer (EBC). Patients and methods A total of 379 eligible women with estrogen receptor positive (ER+), HER2-negative EBC and 0–3 positive lymph nodes were enrolled. Treatment recommendations, patients' decisional conflict, physicians' confidence before and after knowledge of the RS and actual treatment data were recorded. Results Of the 366 assessable patients 244 were node negative (N0) and 122 node positive (N+). Treatment recommendations changed in 33% of all patients (N0 30%, N+ 39%). In 38% of all patients (N0 39%, N+ 37%) with an initial recommendation for chemoendocrine therapy, the post-RS recommendation changed to endocrine therapy, in 25% (N0 22%, N+ 39%) with an initial recommendation for endocrine therapy only to combined chemoendocrine therapy, respectively. A patients' decisional conflict score improved by 6% (P = 0.028) and physicians' confidence increased in 45% (P < 0.001) of all cases. Overall, 33% (N0 29%, N+ 38%) of fewer patients actually received chemotherapy as compared with patients recommended chemotherapy pre-test. Using the test was cost-saving versus current clinical practice. Conclusion RS-guided chemotherapy decision-making resulted in a substantial modification of adjuvant chemotherapy usage in node-negative and node-positive ER+ EBC.
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Affiliation(s)
- W Eiermann
- Interdisciplinary Oncology Center, Munich.
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Albanell J, González A, Ruiz-Borrego M, Alba E, García-Saenz JA, Corominas JM, Burgues O, Furio V, Rojo A, Palacios J, Bermejo B, Martínez-García M, Limon ML, Muñoz AS, Martín M, Tusquets I, Rojo F, Colomer R, Faull I, Lluch A. Prospective transGEICAM study of the impact of the 21-gene Recurrence Score assay and traditional clinicopathological factors on adjuvant clinical decision making in women with estrogen receptor-positive (ER+) node-negative breast cancer. Ann Oncol 2012; 23:625-631. [PMID: 21652577 DOI: 10.1093/annonc/mdr278] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study examined the impact of the Recurrence Score (RS) in Spanish breast cancer patients and explored the associations between clinicopathological markers and likelihood of change in treatment recommendations. PATIENTS AND METHODS Enrollment was offered consecutively to eligible women with estrogen receptor-positive; human epidermal growth factor receptor 2-negative, node-negative breast cancer. Oncologists recorded treatment recommendation and confidence in it before and after knowing the patient's RS. RESULTS Treatment recommendation changed in 32% of 107 patients enrolled: in 21% from chemohormonal (CHT) to hormonal therapy (HT) and in 11% from HT to CHT. RS was associated with the likelihood of change from HT to CHT (P < 0.001) and from CHT to HT (P < 0.001). Confidence of oncologists in treatment recommendations increased for 60% of cases. Higher tumor grade (P = 0.007) and a high proliferative index (Ki-67) (P = 0.023) were significantly associated with a greater chance of changing from HT to CHT, while positive progesterone receptor status (P = 0.002) with a greater probability of changing from CHT to HT. CONCLUSIONS Results from the first prospective European study are consistent with published experience and use of the RS as proposed in European clinical practice guidelines and provide evidence on how Oncotype DX and clinicopathological factors are complementary and patient selection may be improved.
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Affiliation(s)
- J Albanell
- Medical Oncology Service, Hospital del Mar, Barcelona; Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona; Department of Medicine, Autonomous University of Barcelona, Barcelona.
| | - A González
- Medical Oncology Service, MD Anderson, Madrid
| | - M Ruiz-Borrego
- Medical Oncology Service, Hospital Virgen del Rocío, Sevilla
| | - E Alba
- Medical Oncology Service, Hospital Virgen de la Victoria, Málaga
| | | | - J M Corominas
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona; Department of Medicine, Autonomous University of Barcelona, Barcelona; Pathology Service, Hospital del Mar, Barcelona
| | - O Burgues
- Pathology Service, Hospital Clínico, Valencia
| | - V Furio
- Pathology Service, Hospital Clínico, Madrid
| | - A Rojo
- Pathology Service, MD Anderson, Madrid
| | - J Palacios
- Pathology Service, Hospital Virgen del Rocío, Sevilla
| | - B Bermejo
- Department of Hematology and Oncology, Hospital Clínico de Valencia, Valencia
| | - M Martínez-García
- Medical Oncology Service, Hospital del Mar, Barcelona; Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona
| | - M L Limon
- Medical Oncology Service, Hospital Virgen del Rocío, Sevilla
| | - A S Muñoz
- Medical Oncology Service, Hospital Virgen de la Victoria, Málaga
| | - M Martín
- Medical Oncology Service, Hospital Gregorio Marañón Madrid, Madrid
| | - I Tusquets
- Medical Oncology Service, Hospital del Mar, Barcelona; Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona
| | - F Rojo
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona; Pathology Service, Fundación Jiménez Díaz, Madrid
| | - R Colomer
- Medical Oncology Service, MD Anderson, Madrid
| | | | - A Lluch
- Department of Hematology and Oncology, Hospital Clínico de Valencia, Valencia
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