Evidence map›Paper›PMID 33070279›Full record

ArticleBreast cancer research and treatment2021

The 21-gene recurrence score in node-positive, hormone receptor-positive, HER2-negative breast cancer: a cautionary tale from an NCDB analysis.

Roi Weiser, Waqar Haque, Efstathia Polychronopoulou, Sandra S Hatch, Yong-Fang Kuo, William J Gradishar, V Suzanne Klimberg

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Article in Breast cancer research and treatment, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 2 pooled it
0.9field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  10. Escalating de-escalation in breast cancer treatment.Breast cancer research and treatment · 2022
    Article
  11. The Role of the 21-Gene Recurrence ScoreCurrent oncology (Toronto, Ont.) · 2022
    Review
  12. Article
  13. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Roi WeiserDepartment of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA. roweiser@utmb.edu.ORCID http://orcid.org/0000-0002-4522-6404
Waqar HaqueDepartment of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Efstathia PolychronopoulouOffice of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
Sandra S HatchDepartment of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA.
Yong-Fang KuoOffice of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
William J GradisharDepartment of Medicine & Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
V Suzanne KlimbergDepartment of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA. vsklimbe@utmb.edu.
The University of Texas Medical Branch at Galveston · USMethodist Hospital · USNorthwestern University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe 21-gene recurrence score assay (RS) has not been prospectively validated to predict adjuvant chemotherapy benefit in hormone receptor-positive (HR+), HER2-negative (HER2-), node-positive breast cancer patients. Nevertheless, de-escalation based on RS has been demonstrated and partially advocated by retrospective data. The purpose of this study was to identify subgroups of node-positive patients with low to intermediate RS who still benefit from adjuvant chemotherapy.

methodsThe National Cancer Database was used to identify 28,591 women with stage I-III, T1-T3, N1, HR+, HER2- breast cancer and a RS ≤ 25 between 2010 and 2016. Univariate and multivariate analyses were used to identify variables correlating with chemotherapy use and 5-year survival. Subgroup analysis was performed to discern patients in whom the use of adjuvant chemotherapy correlated with better survival.

resultsA 35% decline in chemotherapy use was observed from 2010 to 2016. Patients with younger age, higher RS, larger tumors and more positive lymph nodes, and those treated by mastectomy, axillary lymph node dissection and radiation, were more likely to receive chemotherapy. Chemotherapy use was associated with an improved 5-year survival (HR = 1.63, 95% CI 1.28-2.07). Upon subgroup analysis, this association was lost in patients > 70 years and those with a RS ≤ 11, while patients ≤ 70 with a RS of 12-25 treated with chemotherapy had an absolute 5-year survival advantage of 3.0% (HR = 1.91, 95% CI 1.42-2.57).

conclusionClinicians should be cautious when considering omission of adjuvant chemotherapy in patients ≤ 70 years, with HR+, HER2-, N1 tumors and a RS 12-25, at least until the results of the anticipated RxPONDER trial become available.

Indexed as

Breast NeoplasmsBiomarkers, TumorChemotherapy, AdjuvantFemaleHormonesHumansLymphatic MetastasisMastectomyNeoplasm Recurrence, LocalPrognosisReceptors, EstrogenRetrospective StudiesBiomarkers, TumorHormonesReceptors, Estrogen21-Gene recurrence scoreBreast cancerChemotherapyDe-escalatingEstrogen receptorNode positive

Identifiers

PMID33070279
OpenAlexW3093252884

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.