Abstract
Background
RNA-based genomic risk assessment estimates chemotherapy benefit in patients with
hormone-receptor positive (HR+)/Human Epidermal Growth Factor 2-negative (ERBB2-) breast cancer (BC). It is virtually used in all patients with early HR+/ERBB2- BC regardless of clinical recurrence risk.
Patients and methods
We conducted a retrospective chart review of adult patients with early-stage (T1-3;
N0; M0) HR+/ERBB2- BC who underwent genomic testing using the Oncotype DX (Exact Sciences) 21-genes
assay. Clinicopathologic features were collected to assess the clinical recurrence
risk, in terms of clinical risk score (CRS) and using a composite risk score of distant
recurrence Regan Risk Score (RRS). CRS and RRS were compared to the genomic risk of
recurrence (GRS).
Results
Between January 2015 and December 2020, 517 patients with early-stage disease underwent
genomic testing, and clinical data was available for 501 of them. There was statistically
significant concordance between the 3 prognostication methods (P < 0.01). Within patients with low CRS (n = 349), 9.17% had a high GRS, compared to 8.93%
in patients with low RRS (n = 280). In patients with grade 1 histology (n = 130),
3.85% had a high GRS and 68.46% had tumors > 1 cm, of whom only 4.49% had a high GRS.
Tumor size > 1cm did not associate with a high GRS.
Conclusion
Genomic testing for patients with grade 1 tumors may be safely omitted, irrespective
of size. Our finds call for a better understanding of the need for routine genomic
testing in patients with low grade/low clinical risk of recurrence.
Keywords
Abbreviations:
BC: (Breast ancer), HR: (Hormone Receptor), ERBB2: (Human epidermal growth factor receptor 2), GRS: (Genomic Risk Score), CRS: (Clinical Risk Score), RRS: (Regan Risk Score), ER: (Estrogen Receptor), PR: (Progesterone Receptor), QALY (Quality-Adjusted Life Year)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 22, 2022
Accepted:
November 18,
2022
Received in revised form:
November 17,
2022
Received:
September 3,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
