title: Cross-Stratification and Differential Risk by Breast Cancer Index and Recurrence Score in Women with Hormone Receptor-Positive Lymph Node-Negative Early-Stage Breast Cancer.
abstract: OBJECTIVE
  Previous results from the TransATAC study demonstrated that both the Breast Cancer Index (BCI) and the OncotypeDX Recurrence Score (RS) added significant prognostic information to clinicopathologic factors over a 10-year period. Here, we examined cross-stratification between BCI and RS to directly compare their prognostic accuracy at the individual patient level.
  
  
  METHODS
  A total of 665 patients with hormone receptor-positive (HR+) and lymph node-negative disease were included in this retrospective analysis. BCI and RS risk groups were determined using predefined clinical cut-off points. Kaplan-Meier estimates of 10-year risk of distant recurrence (DR) and log-rank tests were used to examine cross-stratification between BCI and RS.
  
  
  RESULTS
  As previously reported, both RS and BCI were significantly prognostic in years 0 to 10. BCI provided significant additional prognostic information to the Clinical Treatment Score (CTS) plus RS (ΔLR-χ2= 11.09; P < 0.001), whereas no additional prognostic information was provided by RS to CTS plus BCI (ΔLR-χ2= 2.22; P = 0.1). Restratification by BCI of the low and intermediate RS risk groups led to subgroups with significantly different DR rates (P < 0.001 and P = 0.003, respectively). In contrast, restratified subgroups created by RS of BCI risk groups did not differ significantly.
  
  
  CONCLUSIONS
  In this retrospective analysis, BCI demonstrated increased prognostic accuracy versus RS. Notably, BCI identified subsets of RS low and RS intermediate risk patients with significant and clinically relevant rates of DR. These results indicate that additional subsets of women with HR+, lymph node-negative breast cancer identified by BCI may be suitable candidates for adjuvant chemotherapy or extended endocrine therapy. Clin Cancer Res; 22(20); 5043-8. ©2016 AACRSee related commentary by Brufsky and Davidson, p. 4963.
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom. i.sestak@qmul.ac.uk.
authors.forename: Ivana
authors.initials: I
authors.lastname: Sestak
authors.affiliation: bioTheranostics, San Diego, California.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: bioTheranostics, San Diego, California.
authors.forename: Brock E
authors.initials: BE
authors.lastname: Schroeder
authors.affiliation: bioTheranostics, San Diego, California.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Schnabel
authors.affiliation: Institute of Cancer Research and Academic Department of Biochemistry, Royal Marsden Hospital, London, United Kingdom.
authors.forename: Mitch
authors.initials: M
authors.lastname: Dowsett
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Molecular Pathology Unit and Centre for Cancer Research, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Dennis
authors.initials: D
authors.lastname: Sgroi
mesh_terms: D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D005260:Female; D020869:Gene Expression Profiling; D006305:Health Status Indicators; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology; D009570:Nitriles / Q000627:therapeutic use; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D012189:Retrospective Studies; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole