The impact of EndoPredict((R))on decision making with increasing oncological work experience: can overtreatment be avoided?

摘要

BackgroundEstimating distant recurrence risk in women with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer is still challenging. EndoPredict((R)) is a gene expression-based test predicting the likelihood of recurrent disease. We analyzed the difference in oncological decision making with and without the knowledge of gene expression tests.Patients and methodsThis is a retrospective analysis including patients diagnosed with hormone-receptor positive, Her2 negative breast cancer between 2011 and 2015 at the Municipal Breast Cancer Centre Cologne, Germany. All patients received an evaluation by EndoPredict((R)). An oncological tumor board (TB) with knowledge of these results served as a baseline (control group). This baseline was compared to the treatment decision (adjuvant chemotherapy yes vs. no) made by oncologists with different experience levels (less than 5years, between 5 and 15years, and more than 15years) who were not provided the EndoPredict((R)) scores. All clinicians had access to clinical as well to histopathological data.ResultsThere was no significant difference between control group and the oncologists with different experience levels concerning a chemotherapy indication. A trend could be shown in the subgroup of nodal negative patients between the treatment recommendation and physicians with more than 15years of experience (p=0.088). A further trend could be demonstrated in the subgroup of patients with a low Ki67 index (14%) (p=0.063) between physician with 5-10years of clinical experience and official treatment recommendation.ConclusionIt seems that inexperienced physicians may profit from the use of EndoPredict((R)) to avoid an overtreatment. In nodal negative patients and patients with a low Ki67 index, undertreatment can be avoided with the use of EndoPredict((R)) (borderline significance). Further prospective studies with larger study cohorts are needed to further validate this tool.