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.
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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.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 pre-defined clinical cut-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.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 (∆LR-χ2=11.09; P<0.001) whereas no additional prognostic information was provided by RS to CTS plus BCI (∆LR-χ2=2.22; P=0.1). Re-stratification 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, re-stratified subgroups created by RS of BCI risk groups did not differ significantly.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.
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Clinical cancer research : an official journal of the American Association for Cancer Research, 2016