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2012, Número 2

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Gac Med Mex 2012; 148 (2)


Características clinicopatológicas, pronóstico e influencia en el tratamiento adyuvante en los grupos de riesgo de recurrencia determinados por el perfil de expresión de 21 genes, Oncotype Dx®, en cáncer de mama temprano

Gerson CR, Alban TLF, Villalobos PA, Serrano OJA

Idioma: Español
Referencias bibliográficas: 39
Paginas: 117-124
Archivo PDF: 92.96 Kb.


RESUMEN

Antecedentes: La quimioterapia adyuvante (QTA) reduce la recurrencia y mortalidad del cáncer de mama (CM), pero no todas las pacientes requieren QTA. Oncotype Dx® (ODX) explora con la expresión de 21 genes el riesgo de recurrencia del CM. Objetivos: Determinar las características clinicopatológicas, el pronóstico y la prescripción de QTA en CM temprano en los grupos de riesgo definidos por ODX. Métodos: 36 pacientes con CM en etapa I-IIA, operadas, con ganglios negativos o 1-3+, receptores hormonales (RH) + y human epidermal growth factor receptor 2 (HER2) negativo. Se compararon tres grupos designados por ODX: riesgo bajo (GB), intermedio (GI) y alto (GA) de recurrencia. Resultados: GB: 23 pacientes (63.9%), GI: 8 (22.2%) y GA: 5 (13.9%). Detectamos alta expresión de Ki-67 en GI y GA en relación con GB (21.1 y 32.5% vs 10.1%; p = 0.007) y menor intensidad de expresión del receptor de estrógeno (RE) en GA (85.3, 85.4 y 56.9%; p = 0.005). Puntaje de recurrencia GB 12 (0-18), GI 23 (19-27) y GA 47 (36-57); p ‹ 0.000. Antes del ODX se planeó QTA en 21/36 pacientes (58.3%) y después del ODX 9/36 (25%) la recibieron. No observamos recurrencias ni fallecimientos en los grupos. Conclusiones: En CM temprano, el 64% tiene GB de recurrencia. Los casos con GA presentan Ki-67 elevado y menor expresión de RE. Oncotype Dx® modifica la recomendación terapéutica en el 57.2% de los casos.


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