title: Additional value and potential use of the 70-gene prognosis signature in node-negative breast cancer in daily clinical practice.
abstract: BACKGROUND
  The 70-gene prognosis signature has strong prognostic value in node-negative breast cancer, independent of established prognostic factors. It is unclear whether all node-negative patients should receive a signature result. We therefore evaluated its additional prognostic information to a combination of established prognostic guidelines.
  
  
  METHODS
  We evaluated 701 patients from three previously described series in whom a signature result was available. Clinical risk was on the basis of Adjuvant! Online (AO), St Gallen guidelines (St G) and Nottingham Prognostic Index (NPI). Overall survival (OS) analyses were carried out in patients treated at the Netherlands Cancer Institute (Amsterdam) who did not receive adjuvant systemic treatment (AST).
  
  
  RESULTS
  Only 6% (10 of 156) of estrogen receptor (ER)-negative tumours had a good prognosis signature. The signature was not useful for ER-positive tumours and concordant high AO, high St G and/or high NPI clinical risks (N = 139). The 10-year OS estimate for good signature tumours with these characteristics was <80% and AST would therefore be appropriate irrespective of the signature result. In contrast, for patients with a concordant low AO, low St G and/or low NPI risk and in discordant clinical risk patients, the signature identified low-risk patients in whom AST could be safely withheld (10-year OS > 90%).
  
  
  CONCLUSIONS
  The 70-gene prognosis signature provides additional prognostic information especially in ER-positive lymph node-negative breast cancer patients with a predominant low or discordant clinical risk on the basis of AO, St G and/or NPI.
authors: Department of Pathology.
authors: J M
authors: JM
authors: Bueno-de-Mesquita
authors: Department of Medical Oncology, Netherlands Cancer Institute.
authors: G S
authors: GS
authors: Sonke
authors: Department of Pathology; Department of Pathology, Amsterdam Medical Centre, Amsterdam, The Netherlands.
authors: M J
authors: MJ
authors: van de Vijver
authors: Department of Medical Oncology, Netherlands Cancer Institute. Electronic address: s.linn@nki.nl.
authors: S C
authors: SC
authors: Linn
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000145:classification* / Q000235:genetics* / Q000473:pathology; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods* / Q000592:standards; D020022:Genetic Predisposition to Disease; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012044:Regression Analysis; D016019:Survival Analysis