Propensity score analysis of the prognostic value of genomic assays for breast cancer in diverse populations using the National Cancer Data Base

Abstract

Background: Genomic assays such as Oncotype Dx (ODX) and MammaPrint are used for risk-adapted treatment decisions among patients with early breast cancer. However, to the authors' knowledge, concordance between genomic assays is modest. Using real-world data, the authors performed a comparative analysis of ODX and MammaPrint.

Methods: A cohort of women diagnosed with early-stage, hormone receptor-positive breast cancer who received ODX or MammaPrint was established using the National Cancer Data Base (NCDB) for 2010 through 2016. Using the propensity score matching method, 2 groups of patients with similar clinical and demographic characteristics were defined: one group received ODX and the other received MammaPrint. The authors examined the association between use of the ODX or MammaPrint assays and overall survival using Cox models.

Results: Of the 451,693 eligible patients, approximately 45.3% received ODX and 1.8% received MammaPrint testing. The use of ODX increased from 36.1% in 2010 to 49.9% in 2016, whereas use of MammaPrint increased from 0.5% in 2010 to 3.3% in 2016. The authors matched 5042 patients who received ODX with 5042 patients who received MammaPrint. The 5-year risks of death for the MammaPrint low-risk group and the ODX low-risk group were 3.4% and 4.7%, respectively. The prognostic value of MammaPrint was similar to that of ODX; the C-index was 0.614 (95% confidence interval, 0.572-0.657) for MammaPrint and 0.581 (95% confidence interval, 0.530-0.631) for ODX. There was a difference in the performance of the ODX assay observed across racial and/or ethnic groups (P < .001), with a slightly better performance noted among white compared with African American and Hispanic individuals.

Conclusions: Both the ODX and MammaPrint tests are good at identifying low-risk individuals who could be spared chemotherapy. The suboptimal performance of ODX in ethnic minority individuals deserves further investigation.

Keywords: biomarker; breast cancer; endocrine receptor; genomic assay; racial disparity.

Figure 1.

Utilization rate of multigene testing in early stage hormone receptor positive, Her2 negative breast cancer from year 2010 to 2016 in the U.S.

Figure 2.

Kaplan-Meier curve by Mammaprint and Oncotype DX testing results in matched samples. New Oncotype DX category: low risk if recurrence score (RS) <26 and node negative or RS <11 and node positive; high risk if RS >25 and node negative or RS >10 and node positive.