Comparison of Systemic Inflammatory Indices With the Oncotype DX Recurrence Score and the Nottingam Prognostic Index in Early Hormone Receptor Positive Ductal Breast Cancer

Abstract

Background: Adjuvant therapy decisions in hormone receptor positive and human epidermal growth factor receptor 2 negative breast cancer are evolving. The introduction of gene panel testing has significantly reduced the number of patients recommended for chemotherapy by up to two thirds. However, these tests are expensive, highlighting the need to identify low-risk genomic breast cancer cases before testing, which could represent a significant economic impact. The use of systemic inflammatory indices has shown promise as prognostic markers in early breast cancer. We investigated the potential utility of four systemic inflammatory indices with the Nottingham Prognostic Index to predict the Oncotype DX® recurrence scores threshold level (low score or high score), in a cohort of women aged 50 and over with node negative invasive ductal carcinoma of the breast. Methods: A retrospective review of patients who had Oncotype DX® Recurrence Score testing from 2007 to 2021 were identified. After exclusions, the final sample size was 245. Clinicopathological features were collected to calculate the Nottingham Prognostic Index. The systemic inflammatory indices were estimated from preoperative peripheral blood samples. Results: 22.4% of the cohort had a Recurrence Score in the higher risk group. This cohort had a greater percentage of grade 3 tumours, progesterone receptor negativity, higher Nottingham Prognostic Scores, and inflammatory indices ratios than the lower risk group. A decision tree incorporating the Neutrophil Lymphocyte Ratio with clinicopathological features showed potential as an indicator of a high Oncotype DX® RS score, such that further investigation is warranted to assess whether Recurrence Score testing could be triaged in certain cohorts of patients. In this cohort, 38% of patients might be able to avoid genomic testing based on the decision tree analysis. Conclusion: Utility of the inflammatory indices with clinicopathological features may help triage gene panel testing