Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA.
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.
Breast Cancer Res Treat. 2020 Apr;180(2):491-501. doi: 10.1007/s10549-020-05557-x. Epub 2020 Feb 14.
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.
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.
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.
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.
（1）检测 2004-2015 年间激素受体阳性（HR+）乳腺癌（BC）患者中 Oncotype DX（ODX）使用的趋势及相关因素；（2）报告的化疗与复发评分（RS）的趋势；（3）与 ODX 使用相关的生存差异。
将基因组健康公司的 ODX 数据与 17 个 SEER 登记处的数据进行了关联。分析了 2004-2015 年间淋巴结阴性（N0）或 1-3 个阳性淋巴结（N1）的 HR+BC 病例。采用 Cochrane-Armitage 趋势检验、逻辑回归、Kaplan-Meier 生存曲线和分层 Cox 模型进行分析。生存分析仅限于 2010-2014 年的 HR+/HER2-患者，并按倾向评分进行匹配。
ODX 的使用从 2004 年到 2015 年显著增加（N0：2.0%到 42.7%；N1：0.3%到 27.9%）。非西班牙裔黑人和 Medicaid 保险患者接受 ODX 的可能性较低。中等分化或 2.1-5.0cm 肿瘤的 N0 患者和高分化或<2.0cm 肿瘤的 N1 患者使用 ODX 的可能性更高。低和中 RS 组报告的化疗使用率显著下降，而 N0 患者高 RS 组的化疗使用率则上升。ODX 的使用与更好的乳腺癌特异性生存相关[风险比（95%CI）N0 为 1.96（1.60-2.41），N1 为 1.90（1.42-2.54）]和总体生存[N0 为 2.06（1.83-2.31），N1 为 1.72（1.42-2.09）]，尤其是在最初的 36 个月内。
自 2004 年以来，ODX 的使用显著增加，但仍存在差异，尤其是在种族/族裔少数群体和 Medicaid 保险患者中。N0 患者基于 ODX 结果给予化疗的做法得到了改善。接受 ODX 的患者比未接受 ODX 的患者生存情况更好。
