br RS distribution and decision making changes

8. RS distribution and decision-making changes for patients with different pathological types
Of pathological types, as shown in Table 7, 210 (94.6%) patients were diagnosed with invasive breast carcinoma or invasive carcinoma with ductal carcinoma in situ. The distribution of low risk, intermediate risk and high risk were 73 (34.8%), 92 (43.8%), and 45 (21.4%), re-spectively. Before and after 21-ene assay, the invasive carcinoma pa-tients with lower RS scores made obvious changes in treatment
Table 3
Association between RS score and clinical characteristics.
Group Age
Tumor size(cm)
Molecular subtype
Luminal A Luminal B
Negative Positive
Group
Histological grade
E-cadherin
I
II III
Negative Positive
Table 4
Results of logistical analysis.
Factors β SD Wald P OR 95% CI
Table 5
Correlation between RS score and chemotherapy decision-making.
Group Chemotherapy No-chemotherapy Total
Fig. 2. Changes of adjuvant therapy selection by patients before and after 21 gene test.
selection (Table 7); 14.3% of patients with invasive breast cancer with lower risk substituted of chemotherapy with hormone therapy, whereas 8.1% patients with intermediate/high risk changed to an endocrine strategy. For other invasive breast cancer carcinomas, such as invasive lobular breast carcinoma and mucinous breast carcinoma, only 4 out of 
Table 6 Horizontal comparison between 21-gene assay research in different countries.
Country Cases Deletion (%) Addition (%)
Note: C = chemotherapy, H = hormone therapy.
12 patients altered their treatment regimens.
9. Discussion
For breast cancer patients in early stages, it Ruxolitinib is still difficult to choose which patients benefit from chemotherapy with endocrine therapy, although adjuvant chemotherapy has been demonstrated with pro-mising efficacy (Naoi and Noguchi, 2016; Sestak and Cuzick, 2015). Several studies have demonstrated that the Oncotype DX was a prog-nostic profiling multigene expression assay, providing complementary information for treatment planning(Goldstein et al., 2008; Henry et al., 2009). Scientific societies, significantly including the American Society of Clinical Oncology, the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology, have added the 21-gene signature assay to their guidelines, using the 21-gene re-currence risk (RS) evaluation to identify patients who can avoid che-motherapy(Baker, 2015). Several clinical utility studies have demon-strated that RS results affect the management of patients. For the Chinese population, the understanding of the 21-gene RS was limited. Its clinical relationship and decision-making guidance have not been revealed. In this study, we explored the association of RS with clin-icopathological characteristics, as well as the changes of chemotherapy recommendation in 162 cases of breast cancer patients in an early stage after RS evaluation.
Patterns of genomic testing might be affected by clinical factors. In 2014, Sheppard VB examined socio-demographic, clinical, and attitu-dinal factors associated with RS testing receipt and observed that higher age was associated with RS testing adjusting for covariates (Sheppard et al., 2014). In 2015, Fanny Le Du et al. reviewed 1030 patients with estrogen-receptor positive, stage I breast cancer and found that RS was correlated with clinical variables (Le Du et al., 2014). Presently, our
Table 7
Changes of decision-making after 21 gene assay.
Pathology Cases Minus (From C + H to H)
Lower risk Intermediate/high risk Total
Lower risk