Journal of Current Oncology

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 1  |  Issue : 1  |  Page : 5--15

Risk stratification in early-stage estrogen receptor+/HER2-breast cancer patients: Comparative analysis of cost-effective methods


Chandra Prakash, Aparna Gunda, Arun Kumar Attuluri, Lekshmi Madhav, Charusheila Ramkumar, Chetana Basavaraj, Nirupama Naidu, Manjiri M Bakre 
 OncoStem Diagnostics Pvt. Ltd., Bengaluru, Karnataka, India

Correspondence Address:
Dr. Manjiri M Bakre
OncoStem Diagnostics Pvt. Ltd., 4, Raja Ram Mohan Roy Road, Anand Towers, 2nd Floor, Bengaluru - 560 027, Karnataka
India

Context: Treatment decisions in early-stage hormone receptor-positive breast cancer patients are dependent on the potential risk of cancer recurrence. Multiple expensive gene expression based or cost-effective methods are used to assess the risk in conjunction with traditional prognostic determinants – age, tumor parameters – size, node, grade, and gold standard biomarkers-estrogen receptor, progesterone receptor (PR), and Human epidermal growth factor receptor 2. Aim: The aim of this study is to compare the performance of multiple economic methods, namely, (1) Ki67; (2) immunohistochemistry 4 (IHC4)-multi-biomarker test; (3) Luminal A/B subtyping (4) PREDICT-an online tool. Settings and Design: IHC was performed as per standard protocol on a retrospective cohort of 401 patients. The Kaplan–Meier analysis and Cox proportional-hazards model were used. Results: The results confirmed that lymph node status is the most useful prognostic indicator among the traditional clinicopathological parameters. IHC4 had a hazard ratio (HR) of 2.847 and separated the low-, intermediate- and high-risk groups significantly (P = 0.0248). Luminal subtyping (HR = 2.530) also stratified the two risk groups significantly (P = 0.0321), but had HR lesser than IHC4. Ki67 and PREDICT could not separate the cohort into low- and high-risk groups with statistical significance. All tools compared separated the low-, intermediate- and high-risk groups with a maximum of 7% difference in metastasis-free survival significantly less compared to Oncotype Dx, which separates with 28% difference in survival. Conclusions: IHC4 is a significant predictor of prognosis among the four tools tested. However, multiple limitations of IHC4 tool about validation and lack of standardized protocols for IHC create a need for a robust, accurate, and cost-effective risk assessment tool.


How to cite this article:
Prakash C, Gunda A, Attuluri AK, Madhav L, Ramkumar C, Basavaraj C, Naidu N, Bakre MM. Risk stratification in early-stage estrogen receptor+/HER2-breast cancer patients: Comparative analysis of cost-effective methods.J Curr Oncol 2018;1:5-15


How to cite this URL:
Prakash C, Gunda A, Attuluri AK, Madhav L, Ramkumar C, Basavaraj C, Naidu N, Bakre MM. Risk stratification in early-stage estrogen receptor+/HER2-breast cancer patients: Comparative analysis of cost-effective methods. J Curr Oncol [serial online] 2018 [cited 2024 Mar 28 ];1:5-15
Available from: http://www.https://journalofcurrentoncology.org//article.asp?issn=2589-8892;year=2018;volume=1;issue=1;spage=5;epage=15;aulast=Prakash;type=0