Assessment of 21-gene Oncotype DX recurrence score in early breast cancer management decision in a clinical setting.
Patients and Methods
A prospective study of a single tertiary center in Oncology Teaching Hospital, Medical City, carried out from January 2014 – November 2017. A total of 38 node-negative, human epidermal growth factor receptor 2 (HER2) negative women with class I and class II risk group according to St. Gallen criteria and were included in the study.
According to the St. Gallen International Breast Cancer Guidelines, out of 38 patients, two (5.3%) had lowrisk, and 36 (94.7%) had a high risk of recurrence of cancer. Following the St. Gallen guidelines, all patients with low risk of recurrence were concordant with OncotypeDX testing and assigned to low risk by the test, whereas, fromthe remaining 36 high-risk patients, ten(26.3%) were categorized in the intermediate risk group, 16 (42.1%) in the low-risk group and the remaining 10(26.3%) in the high-risk group by the OncotypeDX assay. The use of Oncotype DX affected the treatment decision for a significant number of patients assigned to the high-risk group by use of St. Gallen guidelines alone. The proportion of patients considered for chemo-endocrine therapy reduced significantly (p < 0.001, McNemar’s test) from 36 (94.7%) to17 (44.7%) and the number of patients which would have undergone hormone therapy based on St. Gallen guidelines alone changed from 2 (5.3%) to 21 (55.3%). During a median follow-up of 10.45 months and interquartile range of 4.9–15.53 months, no locoregional/systemic relapses were observed.
We need optimal prediction tools to establish risk recurrence in DCIS. MSKCC nomogram is an excellent prediction tool. Combination two tools, MSKCC-nomogram and VNPI, increase prediction of recurrence in our DCIS patients.
(Citation: Gastric & Breast Cancer 2020; 15(1): 1-7)