The impact of adjuvant chemotherapy on overall survival in premenopausal (age ≤ 50 years) hormone and node positive breast cancer patients with an Oncotype Dx score of 25 or less. A NCDB analysis

Document Type

Journal Article

Publication Date

12-8-2025

Journal

Breast cancer research and treatment

Volume

215

Issue

1

DOI

10.1007/s10549-025-07868-3

Keywords

Adjuvant chemotherapy; Early-stage breast cancer; Hormone positive breast cancer; National cancer database; OncotypeDx; Recurrence score

Abstract

PURPOSE: The RxPONDER trial showed improved outcomes in premenopausal hormone positive breast cancer (BC) with 1-3 nodes and OncotypeDx (RS) score ≤ 25 with adjuvant chemotherapy (Chemo) use. This study aims to determine whether adjuvant chemotherapy improves survival outcomes in young women (≤ 50 years) with node positive, hormone receptor-positive breast cancer and oncotypeDx score ≤ 25. METHODS: The 2010-2018 National Cancer Database was used to include M0 BC patients aged ≤ 50 years with N1-N3 lymph nodes stages, any T stage, and RS ≤ 25. Kaplan-Meier (KM) and multivariate (MV) propensity score (PS) weighted Cox model was used to compare survival between patients without and with chemo. RESULTS: 8628 women were included of which 3519 (40.8%) received chemo. KM curves showed that chemo use had better survival at 10 years (93 vs 91%) compared to hormonal therapy alone. Hazard Ratio (HR) comparison between the 2 groups favored chemo [0.602(0.482,0.751)]. Subgroup analysis for mortality benefits showed favorable results in Caucasian race [0.512(0.348,0.752)], both age groups of 18-40 years [0.429(0.217,0.847) and 41-50 years [0.585(0.394,0.869)], and RS 12-25 [0.549(0.379,0.795)]. CONCLUSIONS: Based on our analysis, chemo use was noted in 40.8% of young, lymph node + BC patients with an RS score of 0-25. This group of patients had a relative overall survival advantage of around 40% with chemo use, further supporting the findings of the RxPONDER trial. This benefit is of particular significance in patients with a RS of 12-25. The survival advantage was present in all patients less than 50 years, regardless of the age subgroups.

Department

Medicine

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