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.
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.
Authors: Laura J van 't Veer; Hongyue Dai; Marc J van de Vijver; Yudong D He; Augustinus A M Hart; Mao Mao; Hans L Peterse; Karin van der Kooy; Matthew J Marton; Anke T Witteveen; George J Schreiber; Ron M Kerkhoven; Chris Roberts; Peter S Linsley; René Bernards; Stephen H Friend Journal: Nature Date: 2002-01-31 Impact factor: 49.962
Authors: M J Piccart; A Di Leo; M Beauduin; A Vindevoghel; J Michel; C Focan; A Tagnon; F Ries; P Gobert; C Finet; M T Closon-Dejardin; J P Dufrane; J Kerger; F Liebens; S Beauvois; S Bartholomeus; S Dolci; J P Lobelle; M Paesmans; J M Nogaret Journal: J Clin Oncol Date: 2001-06-15 Impact factor: 44.544
Authors: Donald A Berry; Constance Cirrincione; I Craig Henderson; Marc L Citron; Daniel R Budman; Lori J Goldstein; Silvana Martino; Edith A Perez; Hyman B Muss; Larry Norton; Clifford Hudis; Eric P Winer Journal: JAMA Date: 2006-04-12 Impact factor: 56.272
Authors: Antonio C Wolff; M Elizabeth H Hammond; Jared N Schwartz; Karen L Hagerty; D Craig Allred; Richard J Cote; Mitchell Dowsett; Patrick L Fitzgibbons; Wedad M Hanna; Amy Langer; Lisa M McShane; Soonmyung Paik; Mark D Pegram; Edith A Perez; Michael F Press; Anthony Rhodes; Catharine Sturgeon; Sheila E Taube; Raymond Tubbs; Gail H Vance; Marc van de Vijver; Thomas M Wheeler; Daniel F Hayes Journal: J Clin Oncol Date: 2006-12-11 Impact factor: 44.544
Authors: J Warwick; E Vardaki; N Fattizzi; I McNeish; A Jeyarajah; D Oram; L Hassan; A Covens; S Duffy; K Reynolds Journal: BJOG Date: 2009-05-28 Impact factor: 6.531