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Trend and survival benefit of Oncotype DX use among female hormone receptor-positive breast cancer patients in 17 SEER registries, 2004–2015

  • Epidemiology
  • Published:
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Abstract

Purpose

To examine (1) the trend and associated factors of Oncotype DX (ODX) use among hormone receptor-positive (HR+) breast cancer (BC) patients in 2004–2015; (2) the trend of reported chemotherapy by Recurrence Score (RS); and (3) the survival differences associated with ODX use.

Methods

ODX data from Genomic Health Inc. were linked with 17 SEER registries data. HR + BC cases with lymph node negative (N0) or 1–3 positive LNs (N1) from 2004–2015 were analyzed. The Cochrane-Armitage trend test, logistic regression, Kaplan–Meier survival curve, and stratified Cox model were performed. Survival analysis was restricted to HR+/HER2− patients from 2010 to 2014, matched on propensity score.

Results

ODX use increased substantially from 2004 to 2015 (N0: 2.0% to 42.7%; N1: 0.3% to 27.9%). Non-Hispanic black and Medicaid insured patients had lower odds of receiving ODX. N0 patients with moderately differentiated or 2.1–5.0 cm tumor and N1 patients with well-differentiated or < 2.0 cm tumor had higher odds of using ODX. The reported chemotherapy use decreased significantly with low and intermediate RS, and increased for high RS among N0 patients. ODX use was associated with better breast cancer-specific survival [hazard ratio (95% CI) N0 1.96 (1.60–2.41), N1 1.90 (1.42–2.54)] and overall survival [N0 2.06 (1.83–2.31), N1 1.72 (1.42–2.09)], especially in the first 36 months.

Conclusion

ODX use has increased significantly since 2004, nonetheless disparities remain, especially for racial/ethnic minorities and Medicaid insured patients. Administering chemotherapy based on ODX results has been improved among N0 patients. Patients receiving ODX had better survival than those not.

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Funding

This study was supported by National Cancer Institute Surveillance, Epidemiology, and End Results program (NCI SEER HHSN261201300016I), the Centers for Disease Control and Prevention National Program of Cancer Registries (CDC NPCR U58DP003915), National Institutes of Health/National Institute on Minority Health and Health Disparities (NIH/NIMHD R15MD012387), and Clemson University internal funding.

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Authors and Affiliations

  1. Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA

    Lu Zhang

  2. Louisiana Tumor Registry/Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3rd floor, New Orleans, LA, 70112, USA

    Mei-Chin Hsieh & Xiao-Cheng Wu

  3. National Cancer Institute, Bethesda, USA

    Valentina Petkov

  4. Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA

    Qingzhao Yu

  5. Health Policy & Systems Management Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA

    Yu-wen Chiu

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Correspondence to Xiao-Cheng Wu.

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Supplementary file1 (DOCX 28 kb)

10549_2020_5557_MOESM2_ESM.tif

Supplementary file2 Supplemental figure 1. Flow chart for patient selection. A. Patient selection for objective 1; B. Patient selection for objective 2; C. Patient selection for objective 3. (TIF 9914 kb)

10549_2020_5557_MOESM3_ESM.tif

Supplementary file3 Supplemental figure 2. Adjusted odds ratio of receiving Oncotype DX test for race/ethnicity (non-Hispanic white patients as reference group), female hormone receptor positive breast cancer patients, 17 SEER registries, 2004-2015. A. Non-Hispanic black patients with negative axillary lymph node; B. Non-Hispanic Asian or Pacific Islander patients with negative axillary lymph node; C. Hispanic patients with negative axillary lymph node; D. Non-Hispanic black patients with 1-3 positive axillary lymph nodes; E. Non-Hispanic Asian or Pacific Islander patients with 1-3 positive axillary lymph nodes; F. Hispanic patients with 1-3 positive axillary lymph nodes. (TIF 130 kb)

10549_2020_5557_MOESM4_ESM.tif

Supplementary file4 Supplemental figure 3. Kaplan-Meier plot of breast cancer-specific survival and overall survival by Oncotype DX test order status, stratified by lymph node status, tumor size, and tumor grade, 17 SEER registries, 2004-2015. A. Negative axillary lymph node, tumor size 0.6-2.0cm, well differentiated; B. Negative axillary lymph node, tumor size 0.6-2.0cm, moderately differentiated; C. Negative axillary lymph node, tumor size 0.6-2.0cm, poorly differentiated/undifferentiated; D. Negative axillary lymph node, tumor size 2.1-5.0cm, well differentiated; E. Negative axillary lymph node, tumor size 2.1-5.0cm, moderately differentiated; F. Negative axillary lymph node, tumor size 2.1-5.0cm, poorly differentiated/undifferentiated; G. 1-3 positive axillary lymph node, tumor size ≤2.0cm, well differentiated; H. 1-3 positive axillary lymph node, tumor size ≤2.0cm, moderately differentiated; I. 1-3 positive axillary lymph node, tumor size ≤2.0cm, poorly differentiated/undifferentiated; J. 1-3 positive axillary lymph node, tumor size 2.1-5.0cm, well differentiated; K. 1-3 positive axillary lymph node, tumor size 2.1-5.0cm, moderately differentiated; L. 1-3 positive axillary lymph node, tumor size 2.1-5.0cm, poorly differentiated/undifferentiated. (TIF 717 kb)

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Zhang, L., Hsieh, MC., Petkov, V. et al. Trend and survival benefit of Oncotype DX use among female hormone receptor-positive breast cancer patients in 17 SEER registries, 2004–2015. Breast Cancer Res Treat 180, 491–501 (2020). https://doi.org/10.1007/s10549-020-05557-x

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