Περίληψη:
Multiparametric assays for risk stratification are widely used in the
management of both node negative and node positive hormone receptor
positive invasive breast cancer. Recent data from multiple sources
suggests that different tests may provide different risk estimates at
the individual patient level. The TEAM pathology study consists of 3284
postmenopausal ER+ve breast cancers treated with endocrine therapy Using
genes comprising the following multi-parametric tests OncotypeDx(R),
Prosigna (TM) and MammaPrint(R) signatures were trained to recapitulate
true assay results. Patients were then classified into risk groups and
survival assessed. Whilst likelihood chi(2) ratios suggested limited
value for combining tests, Kaplan-Meier and LogRank tests within risk
groups suggested combinations of tests provided statistically
significant stratification of potential clinical value. Paradoxically
whilst Prosigna-trained results stratified Oncotype-trained subgroups
across low and intermediate risk categories, only intermediate risk
Prosigna-trained cases were further stratified by Oncotype-trained
results. Both Oncotype-trained and Prosigna-trained results further
stratified MammaPrint-trained low risk cases, and MammaPrint-trained
results also stratified Oncotype-trained low and intermediate risk
groups but not Prosigna-trained results. Comparisons between existing
multiparametric tests are challenging, and evidence on discordance
between tests in risk stratification presents further dilemmas. Detailed
analysis of the TEAM pathology study suggests a complex
inter-relationship between test results in the same patient cohorts
which requires careful evaluation regarding test utility. Further
prognostic improvement appears both desirable and achievable.
Συγγραφείς:
Bartlett, John M. S.
Bayani, Jane
Kornaga, Elizabeth
Xu,
Keying
Pond, Greg R.
Piper, Tammy
Mallon, Elizabeth
Yao,
Cindy Q.
Boutros, Paul C.
Hasenburg, Annette
Dunn, J. A. and
Markopoulos, Christos
Dirix, Luc
Seynaeve, Caroline
van de
Velde, Cornelis J. H.
Stein, Robert C.
Rea, Daniel
