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越来越多的证据支持使用多基因检测对浸润性乳腺癌患者的复发风险进行预测。其中最常用的21基因（Oncotype DX）和70基因（Mamma Print）分别于2005年和2007年获得美国食品药品管理局（FDA）批准用于乳腺癌。 2018年1月21日，《美国外科医师学会杂志》在线发表路易斯维尔大学的研究报告，对乳腺癌多基因检测的使用变化趋势及其对术后化疗的影响进行了大数据分析。 该研究根据美国外科医师学会和美国癌症学会的全国癌症数据库，查询到2011～2014年接受手术切除的所有浸润性乳腺癌女性共47万6128例，并获得其中15万3782例（30.2%）关于多基因检测、激素受体状态、接受化疗情况的信息，对多基因检测的使用变化趋势进行评估，并对21基因和70基因的使用形式进行比较。 结果发现：
因此，乳腺癌患者的多基因检测使用率逐年增加，并且与辅助化疗使用率逐年减少相关。21基因仍为最广泛使用的多基因检测，虽然70基因的使用率也在逐年增加。有必要开展进一步研究确定这些多基因检测对风险评定和术后决策的最佳使用方式。 J Am Coll Surg. 2018 Jan 21. [Epub ahead of print] Multigene Signature Panels and Breast Cancer Therapy: Patterns of Utilization and Impact on Clinical Decision Making. Neal Bhutiani, Michael E. Egger, Nicolás Ajkay, Charles R. Scoggins, Robert CG. Martin II, Kelly M. McMasters. University of Louisville, Louisville, KY. INTRODUCTION: A growing body of evidence supports the use of multigene signature panels (MSPs) in predicting recurrence risk in patients with invasive breast cancer. This study aimed to evaluate trends in MSP use over time and the effect of MSPs on administration of postoperative chemotherapy. METHODS: The National Cancer Database was queried for all women with invasive breast cancer who underwent resection between 2011 and 2014 and had information regarding performance of an MSP, hormone receptor (HR) status, and receipt of chemotherapy. MSP use over time was evaluated and patterns of use of Oncotype DX (ODX) and MammaPrint (MP) were compared. RESULTS: In a total of 476,128 patients, an MSP was obtained in 153,782 (30.2%). MSP use increased over time and was associated with a decreased rate of chemotherapy administration (24.6% MSP vs. 37.2% no MSP, p<0.001). ODX remained the most common MSP used throughout the study period. ODX was used more commonly in stage I disease than MP, while MP was used more commonly in stage II and III disease. MP was more commonly used in HR-negative patients, HER2-positive patients, and patients with positive lymph nodes. Postoperative chemotherapy was administered to a higher proportion of patients assessed with MP than with ODX (41.3% vs. 23.4%, respectively, p<0.001). CONCLUSIONS: Use of MSPs among patients with breast cancer has increased over time and is associated with a decreased use of adjuvant chemotherapy. ODX continues to be the most widely-used MSP, though MP use has increased over time. Future studies are warranted to determine the optimal use of these MSPs in risk-assessment and postoperative decision making. DOI: 10.1016/j.jamcollsurg.2017.12.043 |
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