title: Oncotype DX breast cancer recurrence score can be predicted with a novel nomogram using clinicopathologic data.
abstract: OBJECTIVE
  Oncotype DX (ODX) recurrence score (RS) breast cancer (BC) assay is costly, and performed in only ~1/3 of estrogen receptor (ER)-positive BC patients in the USA. We have now developed a user-friendly nomogram surrogate prediction model for ODX based on a large dataset from the National Cancer Data Base (NCDB) to assist in selecting patients for which further ODX testing may not be necessary and as a surrogate for patients for which ODX testing is not affordable or available.
  
  
  METHODS
  Six clinicopathologic variables of 27,719 ODX-tested ER+/HER2-/lymph node-negative patients with 6-50 mm tumor size captured by the NCDB from 2010 to 2012 were assessed with logistic regression to predict high-risk or low-risk ODXRS test results with TAILORx-trial and commercial cut-off values; 12,763 ODX-tested patients in 2013 were used for external validation. The predictive accuracy of the regression model was yielded using a Receiver Operator Characteristic analysis. Model fit was analyzed by plotting the predicted probabilities against the actual probabilities. A user-friendly calculator version of nomograms is available online at the University of Tennessee Medical Center website (Knoxville, TN).
  
  
  RESULTS
  Grade and progesterone receptor status were the highest predictors of both low-risk and high-risk ODXRS, followed by age, tumor size, histologic tumor type and lymph-vascular invasion (C-indexes-.0.85 vs. 0.88 for TAILORx-trial vs. commercial cut-off values, respectively).
  
  
  CONCLUSIONS
  This is the first study of this scale showing confidently that clinicopathologic variables can be used for prediction of low-risk or high-risk ODXRS using our nomogram models. These novel nomograms will be useful tools to help physicians and patients decide whether further ODX testing is necessary and are excellent surrogates for patients for which ODX testing is not affordable or available.
authors.affiliation: Department of Pathology, University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA. aorucevic@utmck.edu.
authors.forename: Amila
authors.identifier: http://orcid.org/0000-0002-4183-8980
authors.initials: A
authors.lastname: Orucevic
authors.affiliation: Department of Surgery, University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Bell
authors.affiliation: Graduate School of Medicine, University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.
authors.forename: Alison P
authors.initials: AP
authors.lastname: McNabb
authors.affiliation: Department of Surgery, University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Heidel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D049451:Nomograms; D012372:ROC Curve; D011980:Receptors, Progesterone / Q000378:metabolism; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D011980:Receptors, Progesterone
keywords: Clinicopathologic variables predict Oncotype DX score; Nomograms predicting Oncotype DX results; Oncotype DX breast cancer recurrence score