Genomic risk stratification in breast cancer: A 10-year follow-up of a single-institution prospective cohort comparing Oncotype DX and MammaPrint.
Bibliographic record
Abstract
e13083 Background: This study investigates the concordance between the 21-gene recurrence score assay, Oncotype DX (ODX), and the 70-gene signature MammaPrint (MP) in a single academic center and evaluates their correlation with breast cancer outcomes. We previously reported a discordance between MP and ODX results; here, we present a 10-year follow-up survival data. Methods: This prospective cohort study included eighty-six consecutive patients between 2012-2014 with node-negative, hormone receptor-positive breast cancer whose tumor samples were tested using ODX. Based on ODX recurrence scores (RS), patients were treated with either a chemotherapy plus hormonal therapy group or a hormonal therapy-alone group. All patients were per standard practices at our institution. MP was subsequently performed on all samples, classifying patients as either low-risk (MP-L) or high-risk (MP-H). ODX risk classification was defined as intermediate/high risk (ODX-H) for RS ≥ 26 in postmenopausal and ≥ 16 in premenopausal patients (As defined by the TAILORx trial, the addition of chemotherapy to endocrine therapy resulted in an absolute risk reduction of 1.6% in distant recurrence-free survival), and otherwise low risk (ODX-L) (ODX ≤ 26 in postmenopausal or ≤ 15 in premenopausal). Results: In the overall population, the 10-year overall survival (OS), disease recurrence-free survival (DRFS), and breast cancer-free interval (BCFI) were 93%, 91%, and 86%, respectively. Patients classified as ODX-H had lower survival rates (OS: 88%, DRFS: 86%, BCFI: 84%) compared to MP-H patients (OS: 92%, DRFS: 89%, BCFI: 87%). Patients classified as ODX-L had numerically better outcomes than MP-L patients (OS: 100%, DRFS: 97%, BCFI: 89%) compared to (OS: 94%, DRFS: 92%, BCFI: 86%). Approximately 29% of ODX-L patients were classified as MP-H, yet these patients demonstrated favorable long-term outcomes. Conclusions: Despite the limitations of a small sample size, our findings suggest that for patients with node negative hormonal receptor positive breast cancer ODX predicts better prognosis and response to chemotherapy than MP. Future prospective randomized trials directly comparing different genomic assays are warranted to optimize risk stratification and treatment decisions. Breast cancer outcomes based on genomic assay risk classification. Genomic assay / outcomes ODX MP High (n = 51) Low (n = 35) High (n = 37) Low (n = 49) OS 88% 100% 92% 94% DRFS 86% 97% 89% 92% BCFI 84% 89% 87% 86%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".