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Community clinical practice patterns and mortality in patients with intermediate oncotype DX recurrence scores: Who benefits from chemotherapy?
Author(s) -
Ibraheem Abiola F.,
Press David J.,
Olopade Olufunmilayo I.,
Huo Dezheng
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31818
Subject(s) - medicine , hazard ratio , breast cancer , chemotherapy , oncology , proportional hazards model , lymph node , cancer , subgroup analysis , gynecology , confidence interval
Background The Oncotype DX recurrence score (RS) is used as a tool for making decisions about chemotherapy for patients who have hormone receptor (estrogen receptor or progesterone receptor)‐positive, HER2‐negative breast cancer. There is no benefit from chemotherapy among patients aged ≥50 years who have lymph node‐negative disease and an RS from 11 to 25, but the benefit of chemotherapy in the lymph node‐positive group remains unknown. Methods On the basis of data from the National Cancer Data Base between 2010 and 2014, a nationwide, retrospective cohort study included 73,185 women who had stage I through IIIA breast cancer and an RS between 11 and 30. Results Receipt of chemotherapy was associated with a reduced risk of death among patients who had lymph node‐positive breast cancer (hazard ratio [HR] 0.58; 95% confidence interval [CI], 0.45‐0.74; P < .001) after adjusting for other prognostic factors in a multivariable Cox model. The 5‐year survival gain ranged from 1.3% (RS 11‐17 subgroup), to 3.3% (RS 18‐25 subgroup), and to 6.7% (RS 26‐30 subgroup). Among patients who had lymph node‐negative disease, chemotherapy was associated with a reduced risk of death for those with an RS from 25 to 30 (HR, 0.68; 95% CI, 0.48‐0.96; P = .03; 5‐year survival gain, 1.8%), but there was no benefit from chemotherapy for patients who had an RS from 11 to 17 (HR, 0.97; 95% CI, 0.61‐1.55; P = .90), and there was a marginally significant benefit for women who had an RS from 18 to 25 (HR, 0.79; 95% CI, 0.62‐1.00; P = .05). Similar results were observed using propensity score‐matching method. Conclusions The benefit of chemotherapy for patients with breast cancer who have an intermediate RS is driven in a nonlinear fashion by RS: the higher the RS, the larger the absolute benefit. Findings from this study underscore the utility of real‐world data to inform joint decision making in practice.