Treatment when Prognostic Factors Do Not Match St. Gallen Recommendations: Profiling of Prognostic Factors Among HR(+) and HER2(-) Breast Cancer Patients

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2012 Dec 12

PMID 23229849

Authors

Kyoko Satoh

Maki Tanaka

Ayako Yano

Jiang Ying

Tatsuyuki Kakuma

Affiliations

Soon will be listed here.

Abstract

Background: The St. Gallen consensus provides treatment recommendations for breast cancer based on prognostic factors. Although many patients' prognostic patterns are not easily matched with the prognostic patterns listed in the St. Gallen consensus, there has been no systematic investigation reporting the gap between treatment recommendations and actual postoperative treatment choices in clinical practice.

Methods: Four hundred seventy-one patients with hormone receptor-positive [HR(+)] and human epidermal growth factor receptor type 2-negative [HER2(-)] breast cancer were analyzed. These patients were classified into either the "crisp treatment group" or "fuzzy treatment group" based on the definitiveness of postoperative treatment selection based on St. Gallen treatment recommendations. The patients in the fuzzy treatment group were further classified into strata in which patients within each stratum shared the same prognostic factor patterns with similar recurrence rates.

Results: A total of 87.3% of HR(+)HER2(-) patients were designated to the fuzzy treatment group. Four prognostic strata were constructed according to the survival tree model, and revealed that patients with poor prognostic profiles tended to receive endocrine therapy with chemotherapy. This suggests that postoperative chemotherapy is useful, although there was no statistical significance.

Conclusions: We constructed prognostic profiles of patients in the fuzzy treatment group and examined the recurrence rates associated with two treatment regimens within each prognostic profile. These findings are exploratory, but they may be useful for planning prospective studies of the effectiveness of postoperative treatment regimens among patients with a heterogeneous combination of prognostic factors.

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