ABSTRACT
BACKGROUND: Genomic tests are increasingly being used by clinicians when considering adjuvant chemotherapy for patients with oestrogen receptor-positive (ER+), human epidermal growth factor 2-negative (HER2-) breast cancer. The Oncotype DX breast recurrence score assay was the first test available in the UK National Health Service. This study looked at how UK clinicians were interpreting Recurrence Scores (RS) in everyday practice. METHODS: RS, patient and tumour characteristics and adjuvant therapy details were retrospectively collected for 713 patients from 14 UK cancer centres. Risk by RS-pathology-clinical (RSPC) was calculated and compared to the low/intermediate/risk categories, both as originally defined (RS < 18, 18-30 and > 30) and also using redefined boundaries (RS < 11, 11-25 and > 25). RESULTS: 49.8%, 36.2% and 14% of patients were at low (RS < 18), intermediate (RS 18-30) and high (RS > 30) risk of recurrence, respectively. Overall 26.7% received adjuvant chemotherapy. 49.2% of those were RS > 30; 93.3% of patients were RS > 25. Concordance between RS and RSPC improved when intermediate risk was defined as RS 11-25. CONCLUSIONS: This real-world data demonstrate the value of genomic tests in reducing the use of adjuvant chemotherapy in breast cancer. Incorporating clinical characteristics or RSPC scores gives additional prognostic information which may also aid clinicians' decision making.
Subject(s)
Biomarkers, Tumor/genetics , Breast Neoplasms/drug therapy , Clinical Decision-Making , Neoplasm Recurrence, Local/drug therapy , Practice Guidelines as Topic/standards , Research Design , Adult , Aged , Aged, 80 and over , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Chemotherapy, Adjuvant , Female , Follow-Up Studies , Gene Expression Profiling , Humans , Middle Aged , Neoplasm Recurrence, Local/genetics , Neoplasm Recurrence, Local/pathology , Prognosis , Receptor, ErbB-2/metabolism , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , Retrospective Studies , United KingdomSubject(s)
Lymphadenopathy/etiology , Mediastinal Neoplasms/diagnostic imaging , Mediastinal Neoplasms/secondary , Meningeal Neoplasms/pathology , Meningioma/secondary , Aged , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Fatal Outcome , Humans , Male , Mediastinal Neoplasms/pathology , Meningioma/classification , Meningioma/diagnosisABSTRACT
Increased plasma nitrate concentrations from dietary sources of nitrate have proven to benefit exercise performance. Beetroot (BR) contains relatively high levels of nitrate (NO3â»), which increases nitric oxide stores. This study investigated whether dietary nitrate supplementation, in the form of a BR beverage, would improve rowing performance during ergometer repetitions. In a randomized crossover design, 14 well-trained junior male rowers consumed 500 ml of either BR or placebo (PL) daily for 6 d. After supplementation, rowers completed 6 maximal 500-m ergometer repetitions and times were recorded. A 7-d washout period separated the 2 trials. Blood pressure, oxygen saturation, maximum heart rate, urine (specific gravity, pH, and nitrites), and lactates were collected for analysis at baseline and pre- and postperformance. Changes in the mean with 95% confidence limits were calculated. There was a likely benefit to average repetition time in the BR condition, compared with PL (0.4%, 95% confidence limits, ± 1.0%). In particular, Repetitions 4-6 showed an almost certain benefit in rowing time on BR (1.7%, 95% CL, ± 1.0%). The underlying mechanism for the observed results remains unknown, as differences observed in rowers' physiological measures between the 2 conditions were unclear. Conclusively, nitrate supplementation in the form of BR juice resulted in improved maximal rowing-ergometer repetitions, particularly in the later stages of exercise.
