title: 21-Gene recurrence score decreases receipt of chemotherapy in ER+ early-stage breast cancer: an analysis of the NCDB 2010-2013.
abstract: The purpose of this study was to determine if receipt of chemotherapy was associated with utilization of the 21-gene recurrence score assay (RS assay) or with recurrence score (RS) in eligible patients. Using the National Cancer Data Base (NCDB), we identified female patients eligible for RS assay based on National Comprehensive Cancer Network (NCCN) guidelines: age 18-70, ER-positive and HER2-negative early-stage breast cancer diagnosed during 2010-2013. We excluded patients not meeting testing guidelines. Inclusion required result of RS in patients who underwent RS assay and status for receipt of chemotherapy. Multivariable logistic regression models and propensity matched analysis were used to determine associations between RS assay and RS with receipt of chemotherapy. Among 129,765 patients who were eligible, 74,778 underwent RS assay and had results available. Of these, 59.5 % (44,505) had low-risk, 32.0 % (23,920) had intermediate-risk, and 8.5 % (6353) had high-risk RS. Patients with intermediate- and high-risk RS were more likely to receive chemotherapy [OR 12.9 (CI 12.2-13.6), p <0.001 and OR 87.2 (CI 79.6-95.6), p <0.0001], respectively. In both low- and intermediate-risk groups, increasing RS score was significantly associated with increasing odds of receiving chemotherapy [OR 1.10 (CI 1.09-1.12), p <0.0001 and OR 1.26 (CI 1.25-1.27), p <0.0001, respectively, for each point increase in RS]. Receipt of chemotherapy was more likely in patients who did not undergo RS assay compared to those who did, OR 1.21 (CI 1.175-1.249) p <0.0001. The utilization of RS assay and the RS were both strongly associated with chemotherapy receipt. Patients eligible for chemotherapy, based on NCCN criteria, were more likely to receive chemotherapy if they did not undergo RS assay or they had a high RS.
authors: Department of Medical Oncology, Gundersen Health System, 1900 South Avenue, Mail Stop EB2-001, La Crosse, WI, 54601, USA. bmparson@gundersenhealth.org.
authors: Benjamin M
authors: BM
authors: Parsons
authors: Department of Medical Research, Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, USA.
authors: Jeffrey
authors: J
authors: Landercasper
authors: Department of Medical Research, Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, USA.
authors: Angela L
authors: AL
authors: Smith
authors: Department of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors: Ronald S
authors: RS
authors: Go
authors: Department of Medical Research, Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, USA.
authors: Andrew J
authors: AJ
authors: Borgert
authors: Department of Medical Oncology, Gundersen Health System, 1900 South Avenue, Mail Stop EB2-001, La Crosse, WI, 54601, USA.
authors: Leah L
authors: LL
authors: Dietrich
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000378:metabolism; D004358:Drug Therapy; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011960:Receptors, Estrogen / Q000378:metabolism*; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen
keywords: 21-Gene RS; Adjuvant chemotherapy; Breast cancer; NCDB; Oncotype Dx