This retrospective study compared overall survival in women with early-stage HR+/HER2- node-negative breast cancer (pT1b-T2) who received adjuvant chemotherapy via an Oncotype DX-guided pathway (recurrence score ≥26) versus a physician-directed pathway (chemotherapy without genomic testing), using the 2022 National Cancer Database (2010–2022).
Among 56,625 women, the Oncotype-guided group had significantly better overall survival than the physician-directed group (HR 0.906; 95% CI 0.856–0.959; P<0.001), with the benefit most pronounced in patients aged ≥56 years (HR 0.866; 95% CI 0.809–0.927; P<0.001). Findings were consistent across IPTW and Bayesian latent confounding analyses.
- Retrospective database design cannot fully exclude residual confounding, despite robust analytical methods. - Oncotype DX recurrence scores for the physician-directed group are unknown, so prognostic risk may differ systematically between groups. - Overall survival is the only endpoint; breast cancer–specific survival and recurrence data are not available in the NCDB.
Genomic testing with Oncotype DX to guide chemotherapy decisions is associated with better survival outcomes than clinicopathologic-based decisions alone, especially in women aged 56 and older with HR+/HER2- early breast cancer. Clinicians should prioritize Oncotype DX testing before deciding on adjuvant chemotherapy in this population.
Explore related topics
