Chapter 2
Predicted overall survival (%)
90 Hajage_F
85 Hajage_D
80 75
Bhoo-Pathy
70
Campbell Olivotto
Mook
65 60 55 50 50
55
60
65
70
75
80
85
90
Observed overall survival (%)
Figure 3 Overall survival predicted by Adjuvant! versus observed
Comparisons between RPM or RPM compared to clinical guidelines Thirteen studies compared MammaPrint to NPI and Adjuvant!, and/or to existing international guidelines, such as the St. Gallen consensus guidelines and the NIH guidelines (58-61). MammaPrint was reported to provide additional prognostic information especially in ER-positive lymph node negative breast cancer patients deemed to have a low clinical risk by Adjuvant! and/or NPI (58). A small-scale study in a German population (>60 years) found a discordance rate between MammaPrint and Adjuvant! of 48% (n=60) if these RPM were used separately (60). Instead of using them separately, if MammaPrint was used in combination with the clinicopathological factors from Adjuvant!, the recommendation differed in 11 of the 60 (18%) patients in the study. This would have led to six additional patients being advised adjuvant chemotherapy and five patients being spared systemic treatment (60). Gevensleben et al. (59) found a similar discordance, namely of 41%, between MammaPrint and Adjuvant! in a German population (N=140) (59). They reported that combining the MammaPrint results with clinicopathological factors would have resulted in altered treatment recommendations in 41% of the patients (57 of 140). Of these patients 45 were classified as having a ‘high’ recurrence risk by Adjuvant!, while MammaPrint classified them as low risk; hence 41% of patients were potentially over- or undertreated (59). A small study in Korean patients (N=36) comparing MammaPrint classification to other clinicopathological classifications,
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