The use of a prognostic table to aid decision making on adjuvant therapy for women with early breast cancer

Feldman, M; Stanford, Richard Fj; Catcheside, Adrienne; Stotter, A.

doi:10.1053/ejso.2002.1300

Cited by 19 publications

(9 citation statements)

References 10 publications

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“…Untreated patients in this group with lymph node-negative disease have a 95% 10-year survival probability-equivalent to that of an age-matched female population without breast cancer (35). Thus, patients in this group are routinely not recommended for postoperative adjuvant therapy (34)(35)(36). We compared the EPGs, as defined by the NPI and ggNPI stratifications, in a subset of 142 lymph node-negative patients who received no adjuvant systemic therapy.…”

Section: Resultsmentioning

confidence: 99%

Genetic Reclassification of Histologic Grade Delineates New Clinical Subtypes of Breast Cancer

et al. 2006

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Histologic grading of breast cancer defines morphologic subtypes informative of metastatic potential, although not without considerable interobserver disagreement and clinical heterogeneity particularly among the moderately differentiated grade 2 (G2) tumors. We posited that a gene expression signature capable of discerning tumors of grade 1 (G1) and grade 3 (G3) histology might provide a more objective measure of grade with prognostic benefit for patients with G2 disease. To this end, we studied the expression profiles of 347 primary invasive breast tumors analyzed on Affymetrix microarrays. Using class prediction algorithms, we identified 264 robust grade-associated markers, six of which could accurately classify G1 and G3 tumors, and separate G2 tumors into two highly discriminant classes (termed G2a and G2b genetic grades) with patient survival outcomes highly similar to those with G1 and G3 histology, respectively. Statistical analysis of conventional clinical variables further distinguished G2a and G2b subtypes from each other, but also from histologic G1 and G3 tumors. In multivariate analyses, genetic grade was consistently found to be an independent prognostic indicator of disease recurrence comparable with that of lymph node status and tumor size. When incorporated into the Nottingham prognostic index, genetic grade enhanced detection of patients with less harmful tumors, likely to benefit little from adjuvant therapy. Our findings show that a genetic grade signature can improve prognosis and therapeutic planning for breast cancer patients, and support the view that low-and high-grade disease, as defined genetically, reflect independent pathobiological entities rather than a continuum of cancer progression.

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Section: Resultsmentioning

confidence: 99%

Genetic Reclassification of Histologic Grade Delineates New Clinical Subtypes of Breast Cancer

et al. 2006

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“…Included studies of patient decision-aids for treatment of early stage breast 1 AET: adjuvant endocrine therapy; ALND: axillary lymph node dissection; AT: adjuvant therapy; BCS: breast conserving surgery; CT: chemotherapy; DA: decision aid; DCIS: ductal carcinoma in situ; DCS: decisional conflict score; EBC: early breast cancer; ER+: estrogen receptor positive; IES: impact of events scale; N/a: not applicable; nr: not reported; RCT: randomised controlled trial; SDM: shared decision-making; SLNB: sentinel lymph node dissection. Breast cancer decision aid systematic review (Belkora, Hutton et al 2011) 2 1 2 1 0 0 0 2 0 2 0 1 1 1 0.46 (Belkora, Volz et al 2012) 2 1 1 1 N/A N/A N/A 1 2 2 0 1 2 2 0.68 (Dhage, Castaneda et al 2013) 1 1 1 0 N/A N/A N/A 0 0 0 0 0 1 1 0.23 (Feldman, Stanford et al 2002) 2 1 2 0 N/A N/A N/A 1 2 0 0 0 1 0 0.41 (Goel, Sawka et al 2001) 2 2 2 1 2 0 0 2 1 2 1 1 1 1 0.64 (Harwood, Douglas et al 2011) 2 0 1 1 N/A N/A N/A 2 0 1 2 1 2 1 0.59 (Heller, Parker et al 2008) 1 2 1 1 2 0 0 1 1 2 1 1 2 1 0.57 (Irwin, Arnold et al 1999) 2 1 1 2 N/A N/A N/A 0 N/A 2 N/A N/A 2 1 0.69 (Jibaja-Weiss, 2 0 1 1 N/A N/A N/A 1 2 2 2 1 2 1 0.68 (Jibaja-Weiss, Volk et al 2011) 1 2 1 1 2 0 0 1 2 2 0 1 2 1 0.57 (Lam, Chan et al 2013) 2 2 1 2 2 2 0 2 2 2 2 2 2 2 0.89 (Lee, Chen et al 2010) 1 1 1 1 0 0 0 0 2 1 0 0 1 2 0.36 (Levine, Gafni et al 1992) 1 1 0 1 N/A N/A N/A 0 N/A 0 N/A 1 1 0 0.28 Breast cancer decision aid systematic review (Lipkus, Peters et al 2010) 1 0 1 2 N/A N/A N/A 1 2 2 2 1 2 2 0.73 (Molenaar, Sprangers et al 2001) 2 1 2 2 N/A N/A N/A 1 2 2 2 1 2 2 0.86 (Peate, Meiser et al 2012) 2 2 2 2 N/A N/A N/A 2 2 2 2 2 2 2 1.00 (Peate, Meiser et al 2011) 0 1 1 1 N/A N/A N/A 0 N/A N/A N/A N/A 1 1 0.36 (Peele, Siminoff et al 2005) 2 2 2 2 2 0 0 2 2 2 2 1 2 1 0.79 (Sheppard, Figueiredo et al 2008) 1 1 1 2 N/A N/A N/A 0 N/A 1 N/A N/A 1 1 0.50 (Sherman, Harcourt et al 2014) 0 2 1 2 N/A N/A N/A 0 N/A N/A N/A N/A 1 2 0.57 (Sherman, Harcourt et al 2013) 1 1 0 0 1 0 0 0 1 1 0 1 1 1 0.29 (Siminoff, Gordon et al 2006) 1 2 2 2 2 0 0 1 2 2 2 2 2 1 0.75 (Sivell, Edwards et al 2012) 2 2 1 2 N/A N/A N/A 1 2 1 0 0 2 2 0.68 (Street, Voigt et al 1995) 2 2 2 2 1 0 0 2 1 1 0 0 2 2 0.61 (Vickers, Elkin et al 2009) 2 2 2 2 2 0 0 2 2 1 2 0 2 1 0.71…”

Section: Resultsmentioning

confidence: 99%

A systematic review of decision aids for patients making a decision about treatment for early breast cancer

et al. 2016

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Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.

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“…Recommendations for systemic treatment are made by some, for example, the NCCN recommends adjuvant chemotherapy for tumours > 1 cm in combination, with adjuvant hormonal and traztuzumab depending on receptor status, but not for small (≤ 5 mm), node-negative invasive tumours or for node-negative grade 1 tumours between 6 mm and 1 cm. In the UK, the NPI is used widely to inform decisions on adjuvant therapy [ 59 , 60 ], however, there is no agreement on cut-off values. The prognostic value of the NPI is supported from validation studies but no new prognostic factors have been shown that add substantially to its use.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis confirms BCL2 is an independent prognostic marker in breast cancer

et al. 2008

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Background: A number of protein markers have been investigated as prognostic adjuncts in breast cancer but their translation into clinical practice has been impeded by a lack of appropriate validation. Recently, we showed that BCL2 protein expression had prognostic power independent of current used standards. Here, we present the results of a meta-analysis of the association between BCL2 expression and both disease free survival (DFS) and overall survival (OS) in female breast cancer.

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The use of a prognostic table to aid decision making on adjuvant therapy for women with early breast cancer

Cited by 19 publications

References 10 publications

Genetic Reclassification of Histologic Grade Delineates New Clinical Subtypes of Breast Cancer

Genetic Reclassification of Histologic Grade Delineates New Clinical Subtypes of Breast Cancer

A systematic review of decision aids for patients making a decision about treatment for early breast cancer

Meta-analysis confirms BCL2 is an independent prognostic marker in breast cancer

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