How to Tackle Discordance in Adjuvant Chemotherapy Recommendations by Using Oncotype DX Results, in Early-Stage Breast Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Mean (min.-max. Value) | Categories (%) |
---|---|---|
age (year) | 52.9 (25–75) | |
<50 year | 86 (43%) | |
≥50 year | 115 (57%) | |
grade I | 10 (5%) | |
grade II | 122 (60.1%) | |
grade III | 69 (34.3%) | |
pT (mm) | 26 (2.8–85) | |
1a | 1 (0.5%) | |
1b | 2 (1%) | |
1c | 79 (39.3%) | |
2 | 106 (52.7%) | |
3 | 13 (6.5%) | |
pN | ||
0 | 102 (50.7%) | |
1 | 98 (48.8%) | |
2 | 1 (0.5%) | |
ER (%) | 94 (1–100) | |
PR (%) | 59 (0–100) | missing: 1 |
Ki67 (%) | 20 (<1–60) | |
MAI | 12.5 (1–65) | missing: 6 |
No positive lymph node | 0.73 (0–5) | |
No excised lymph nodes | 4.16 (1–31) | |
perinodal infiltration | ||
yes | 62 (30.8%) | |
no | 25 (12.4%) | |
missing | 12 (6%) | |
TILs (%) | 5.8 (0–70) | missing: 24 (11.9%) |
vascular invasion | ||
yes | 90 (44.8%) | |
no | 102 (50.7%) | |
missing | 10 (5%) | |
NPI | 4.31 (2.5–5.7) | |
RS | 19.85 (0–66) | |
0–10 | 33 (16.4%) | |
11–15 | 31 (15.4%) | |
16–20 | 48 (23.9%) | |
21–25 | 48 (23.9%) | |
26–30 | 14 (7%) | |
>30 | 27 (13.4%) | |
adjuvant chemotherapy | ||
yes | 46 (22.9%) | |
no | 155 (77%) |
Oncologist | Pre-RS | Post-RS | CT Recommendation Decrease (Percentage of All Patients) | Change from CT to No-CT | Change from No-CT to CT | All Changes | ||
---|---|---|---|---|---|---|---|---|
No-CT | CT | No-CT | CT | |||||
treating physician | 82 (41%) | 119 (59%) | 128 (63.7%) | 61 (30.3%) | 48.7% (28.9%) uncertain after RS:12 (6%) | 60 (29.9%) | 10 (5%) | 70 (34.9%) |
oncologist 1 | 51 (25.4%) | 150 (74.6%) | 110 (54.7%) | 91 (45.3%) | 35% (26.4%) | 69 (34.3%) | 10 (5%) | 79 (39.3) |
oncologist 2 | 77 (38.3%) | 124 (61.7%) | 139 (69.2%) | 62 (62%) | 50% (30.8%) | 71 (35.3%) | 9 (4.5%) | 80 (39.8%) |
oncologist 3 | 92 (45.8%) | 109 (54.2%) | 116 (57.7%) | 84 (41.8%) | 22.9% (12.4%) | 40 (19.9%) | 16 (8%) | 56 (27.9%) |
oncologist 4 | 55 (27.4%) | 146 (72.6%) | 134 (66.7%) | 67 (33.3%) | 54.1% (39.3%) | 82 (40.8%) | 3 (1.5%) | 85 (42.3%) |
oncologist 5 | 127 (63.2%) | 74 (36.8%) | 140 (69.7%) | 61 (30.3%) | 17.6% (6.5%) | 33 (16.4%) | 20 (10%) | 53 (26.4%) |
average of oncologists 1–5 | 80.4 (40%) | 120.6 (60%) | 127.8 (63.6%) | 73 (36.3%) | 39.5% (23.7%) | 56.4 (28.1%) | 14.2 (7%) | 70.6 (35%) |
Agreement Level | Pre-RS | Post-RS | ||
---|---|---|---|---|
complete concordance | 74 (36.8%) | no-CT: 23 (11.4%) | 153 (76.1%) | no-CT 103 (51.2%) |
CT: 51 (25.4%) | CT 50 (24.9%) | |||
concordant | 69 (34.3%) | no-CT: 28 (13.9%) | 25 (12.4%) | no-CT 14 (7%) |
CT: 41 (20.4%) | CT 11 (5.4%) | |||
discordance | 58 (28.9%) | 23 (11.4%) |
NCCN Category (Number of Patients) | Concord 0 | Concord 1 | Concord 2 | Concord 3 | Concord 4 | Concord 5 |
---|---|---|---|---|---|---|
no-CT (n = 104) | 93 | 6 | 1 | 4 | 0 | 0 |
CT (n = 41) | 0 | 0 | 0 | 0 | 1 | 40 |
consider CT (n = 56) | 10 | 8 | 11 | 7 | 10 | 10 |
Pre-RS Test Opinion for Chemotherapy by Experts | Number | RS Result | Final Decision of Experts | Chemotherapy Was Given |
---|---|---|---|---|
CCA | 23 | all RS ≤ 24 | CCA: 23 CA: 1 ambiguous: 1 | 1 |
CA | 28 | RS ≤ 25: 27 RS ≥ 26: 1 | CCA: 24 CA: 3 ambiguous: 1 CCF: 1 | 0 |
CF | 41 | RS ≤ 25: 34 RS ≥ 26: 7 | CCA: 16 CA: 4 ambiguous: 7 CF: 3 CCF: 11 | 9 |
CCF | 51 | RS ≤ 25: 26 RS ≥ 26: 25 | CCA: 9 CA: 2 ambiguous: 5 CF: 4 CCF: 30 | 26 |
Age | Grade (1–2 vs. 3) | T (1 vs. 2–3) | N (0 vs. 1) | ER (≥30% vs. <30%) | PR (≥30% vs. <30%) | Ki67 (≥20% vs. <20%) | MAI (≥20 vs. <20) | Vascular Invasion (Yes vs. No) | |
---|---|---|---|---|---|---|---|---|---|
O1 | ** | *** | |||||||
O2 | *** | * | *** | *** | * | *** | |||
O3 | *** | *** | * | ** | *** | ||||
O4 | *** | * | *** | ** | |||||
O5 | * | *** | *** | * | * | *** | *** | ** |
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Share and Cite
Boér, K.; Kaposi, A.; Kocsis, J.; Horváth, Z.; Madaras, B.; Sávolt, Á.; Klément, G.B.; Rubovszky, G. How to Tackle Discordance in Adjuvant Chemotherapy Recommendations by Using Oncotype DX Results, in Early-Stage Breast Cancer. Cancers 2024, 16, 2928. https://doi.org/10.3390/cancers16172928
Boér K, Kaposi A, Kocsis J, Horváth Z, Madaras B, Sávolt Á, Klément GB, Rubovszky G. How to Tackle Discordance in Adjuvant Chemotherapy Recommendations by Using Oncotype DX Results, in Early-Stage Breast Cancer. Cancers. 2024; 16(17):2928. https://doi.org/10.3390/cancers16172928
Chicago/Turabian StyleBoér, Katalin, Ambrus Kaposi, Judit Kocsis, Zsolt Horváth, Balázs Madaras, Ákos Sávolt, Gyorgy Benjamin Klément, and Gábor Rubovszky. 2024. "How to Tackle Discordance in Adjuvant Chemotherapy Recommendations by Using Oncotype DX Results, in Early-Stage Breast Cancer" Cancers 16, no. 17: 2928. https://doi.org/10.3390/cancers16172928