Background: The use of the Oncotype DX test reduces the rate of adjuvant chemotherapy recommendations. Few in-depth analyses have been performed on this decision-making process. Methods: We retrospectively analyzed patient data based on available Oncotype DX test results (RS) irrespective of nodal status at a single center. We collected recommendations from six oncologists, first without RS (pre-RS) and then with RS results (post-RS). We investigated changes in recommendations, agreement between oncologist decisions, and the effect of different National Comprehensive Cancer Network (NCCN) recommendation categories (for, against, and considering chemotherapy). Results: Data from 201 patients were included in the analysis. Recommendation of chemotherapy decreased by an average of 39.5%. Agreement improved substantially with RS, with a kappa value pre-RS of 0.37 (fair agreement) and post-RS of 0.75 (substantial agreement). Discordance remained substantial in cases where the NCCN recommendations considered chemotherapy only (32%). Pre-RS consensus against chemotherapy predicted low RS results (50 out of 51 patients). Post-RS consensus was highest in the NCCN chemotherapy recommendation group. Conclusions: The Oncotype DX test substantially improves decision accuracy in recommending adjuvant chemotherapy. It may be further improved with a consensus decision. In the case of pre-RS consensus against chemotherapy, the test can be spared.
背景：Oncotype DX检测的应用降低了辅助化疗的推荐率，但针对这一决策过程的深入分析尚不多见。方法：我们在单中心回顾性分析了基于现有Oncotype DX检测结果（复发评分，RS）的患者数据，不考虑淋巴结状态。我们收集了六位肿瘤科医生的治疗建议，首先在不提供RS的情况下（RS前），随后在提供RS结果后（RS后）。我们研究了建议的变化、肿瘤科医生决策间的一致性，以及不同国家综合癌症网络（NCCN）推荐类别（推荐、不推荐和考虑化疗）的影响。结果：共纳入201例患者数据进行分析。化疗推荐率平均下降了39.5%。提供RS后决策一致性显著改善，RS前的Kappa值为0.37（一致性一般），RS后为0.75（一致性良好）。在NCCN仅建议考虑化疗的病例中，决策不一致性仍然较高（32%）。RS前达成不化疗共识的病例预测了低RS结果（51例患者中有50例）。在NCCN推荐化疗的组别中，RS后的共识度最高。结论：Oncotype DX检测显著提高了推荐辅助化疗的决策准确性。通过共识决策可能进一步改善其效果。对于RS前已达成不化疗共识的病例，可考虑免于进行此项检测。
肿瘤(癌症)患者之家