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Comparison of EndoPredict and EPclin With Oncotype DX Recurrence Score for Prediction of Risk of Distant Recurrence After Endocrine Therapy.

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Publication Date
2016-11
ICR Author
Dowsett, Mitch
Buus, Richard
Author
Buus, R
Sestak, I
Kronenwett, R
Denkert, C
Dubsky, P
Krappmann, K
Scheer, M
Petry, C
Cuzick, J
Dowsett, M
Type
Journal Article
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Abstract
<h4>Background</h4>Estimating distant recurrence (DR) risk among women with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 (HER2)-negative early breast cancer helps decisions on using adjuvant chemotherapy. The 21-gene Oncotype DX recurrence score (RS) is widely used for this. EndoPredict (EPclin) is an alternative test combining prognostic information from an eight-gene signature (EP score) with tumor size and nodal status. We compared the prognostic information provided by RS and EPclin for 10-year DR risk.<h4>Methods</h4>We used likelihood ratio χ² and Kaplan-Meier survival analyses to compare prognostic information provided by EP, EPclin, RS, and the clinical treatment score (CTS) of clinicopathologic parameters in 928 patients with ER+ disease treated with five years' anastrozole or tamoxifen. Comparisons were made for early (0-5 years) and late (5-10 years) DR according to nodal status. All statistical tests were two-sided.<h4>Results</h4>In the overall population, EP and EPclin provided substantially more prognostic information than RS (LRχ(2): EP = 49.3; LRχ(2): EPclin = 139.3; LRχ(2): RS = 29.1), with greater differences in late DR and in node-positive patients. EP and EPclin remained statistically significantly prognostic when adjusted for RS (ΔLRχ(2): EP+RS vs RS = 20.2; ΔLRχ(2): EPclin+RS vs RS = 113.8). Using predefined cut-offs, EPclin and RS identified 58.8% and 61.7% patients as low risk, with hazard ratios for non-low vs low risk of 5.99 (95% confidence interval [CI] = 3.94 to 9.11) and 2.73 (95% CI = 1.91 to 3.89), respectively.<h4>Conclusions</h4>EP and EPclin were highly prognostic for DR in endocrine-treated patients with ER+, HER2-negative disease. EPclin provided more prognostic information than RS. This was partly but not entirely because of EPclin integrating molecular data with nodal status and tumor size.
URL
https://repository.icr.ac.uk/handle/internal/91
Collections
  • Breast Cancer Research
  • Molecular Pathology
Licenseref URL
https://creativecommons.org/licenses/by-nc/4.0
Version of record
10.1093/jnci/djw149
Subject
Lymph Nodes
Humans
Breast Neoplasms
Lymphatic Metastasis
Tamoxifen
Nitriles
Triazoles
Receptor, erbB-2
Receptors, Estrogen
Antineoplastic Agents, Hormonal
Prognosis
Disease-Free Survival
Tumor Burden
Likelihood Functions
Risk Assessment
Follow-Up Studies
Predictive Value of Tests
Female
Kaplan-Meier Estimate
Anastrozole
Research team
Endocrinology
Language
eng
Date accepted
2016-05-09
License start date
2016-11
Citation
Journal of the National Cancer Institute, 2016, 108 (11)

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