A novel machine learning-derived decision tree including uPA/PAI-1 for breast cancer care.
Fiche publication
Date publication
décembre 2018
Journal
Clinical chemistry and laboratory medicine
Auteurs
Membres identifiés du Cancéropôle Est :
Dr ALPY Fabien, Pr CHENARD Marie-Pierre, Pr LESSINGER Jean-Marc, Dr LUPORSI Elisabeth, Pr MATHELIN Carole, Dr TOMASETTO Catherine
Tous les auteurs :
Reix N, Lodi M, Jankowski S, Molière S, Luporsi E, Leblanc S, Scheer L, Ibnouhsein I, Benabu JC, Gabriele V, Guggiola A, Lessinger JM, Chenard MP, Alpy F, Bellocq JP, Neuberger K, Tomasetto C, Mathelin C
Lien Pubmed
Résumé
Background uPA and PAI-1 are breast cancer biomarkers that evaluate the benefit of chemotherapy (CT) for HER2-negative, estrogen receptor-positive, low or intermediate grade patients. Our objectives were to observe clinical routine use of uPA/PAI-1 and to build a new therapeutic decision tree integrating uPA/PAI-1. Methods We observed the concordance between CT indications proposed by a canonical decision tree representative of French practices (not including uPA/PAI-1) and actual CT prescriptions decided by a medical board which included uPA/PAI-1. We used a method of machine learning for the analysis of concordant and non-concordant CT prescriptions to generate a novel scheme for CT indications. Results We observed a concordance rate of 71% between indications proposed by the canonical decision tree and actual prescriptions. Discrepancies were due to CT contraindications, high tumor grade and uPA/PAI-1 level. Altogether, uPA/PAI-1 were a decisive factor for the final decision in 17% of cases by avoiding CT prescription in two-thirds of cases and inducing CT in other cases. Remarkably, we noted that in routine practice, elevated uPA/PAI-1 levels seem not to be considered as a sufficient indication for CT for N≤3, Ki 67≤30% tumors, but are considered in association with at least one additional marker such as Ki 67>14%, vascular invasion and ER-H score <150. Conclusions This study highlights that in the routine clinical practice uPA/PAI-1 are never used as the sole indication for CT. Combined with other routinely used biomarkers, uPA/PAI-1 present an added value to orientate the therapeutic choice.
Référence
Clin. Chem. Lab. Med.. 2018 Dec 20;: