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Multicenter Study
. 2019 Aug;8(9):4176-4188.
doi: 10.1002/cam4.2323. Epub 2019 Jun 14.

Risk stratification of ER-positive breast cancer patients: A multi-institutional validation and outcome study of the Rochester Modified Magee algorithm (RoMMa) and prediction of an Oncotype DX® recurrence score <26

Bradley M Turner  1 , Mary Ann Gimenez-Sanders  2 , Armen Soukiazian  3 , Andrea C Breaux  2 , Kristin Skinner  4 , Michelle Shayne  5 , Nyrie Soukiazian  6 , Marilyn Ling  7 , David G Hicks  8
Affiliations
Multicenter Study

Risk stratification of ER-positive breast cancer patients: A multi-institutional validation and outcome study of the Rochester Modified Magee algorithm (RoMMa) and prediction of an Oncotype DX® recurrence score <26

Bradley M Turner et al. Cancer Med. 2019 Aug.

Abstract

The skyrocketing cost of health-care demands that we question when to use multigene assay testing in the planning of treatment for breast cancer patients. A previously published algorithmic model gave recommendations for which cases to send out for Oncotype DX® (ODX) testing. This study is a multi-institutional validation of that algorithmic model in 620 additional estrogen receptor positive breast cancer cases, with outcome data on 310 cases, named in this study as the Rochester Modified Magee algorithm (RoMMa). RoMMa correctly predicted 85% (140/164) and 100% (17/17) of cases to have a low- or high-risk ODX recurrence score, respectively, consistent with the original publication. Applying our own risk stratification criteria, in patients who received appropriate hormonal therapy, only one of the 45 (2.0%) patients classified as low risk by our original algorithm have been associated with a breast cancer recurrence over 5-10 years of follow-up. Eight of 116 (7.0%) patients classified as low risk by ODX have been associated with a breast cancer recurrence with up to 11 years of follow-up. In addition, 524 of 537 (98%) cases from our total population (n = 903) with an average modified Magee score ≤18 had an ODX recurrence score <26. Patients with an average modified Magee score ≤18 or >30 may not need to be sent out for ODX testing. By avoiding these cases sending out for ODX testing, the potential cost savings to the health-care system in 2018 are estimated to have been over $100,000,000.

Keywords: ER+ breast cancer; Oncotype DX®; RoMMa; algorithm; recurrence.

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Conflict of interest statement

All authors have no conflict of interest.

Figures

Figure 1
Figure 1
Number of cases (patients) used for the validation and outcome evaluations
Figure 2
Figure 2
Patients used for the outcome evaluations
Figure 3
Figure 3
A, Correlation of average modified Magee recurrence score and Oncotype DX® recurrence score from the original publication.31 B, Correlation of average modified Magee recurrence score and Oncotype DX® recurrence score in the validation population
Figure 4
Figure 4
Rochester Modified Magee algorithm (RoMMa)
See this image and copyright information in PMC

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