A Novel Surrogate Nomogram Capable of Predicting OncotypeDX Recurrence Score

Background: OncotypeDX Recurrence Score(C) (RS) is a commercially available 21-gene expression assay which estimates prognosis and guides chemoendocrine prescription in early-stage estrogen-receptor positive, human epidermal growth factor receptor-2-negative (ER+/HER2-) breast cancer. Limitations of RS testing include the cost and turnaround time of several weeks. Aim: Our aim is to develop a user-friendly surrogate nomogram capable of predicting RS. Methods: Multivariable linear regression analyses were performed to determine predictors of RS and RS > 25. Receiver operating characteristic analysis produced an area under the curve (AUC) for each model, with training and test sets were composed of 70.3% (n = 315) and 29.7% (n = 133). A dynamic, user-friendly nomogram was built to predict RS using R (version 4.0.3). Results: 448 consecutive patients who underwent RS testing were included (median age: 58 years). Using multivariable regression analyses, postmenopausal status (beta-Coefficient: 0.25, 95% confidence intervals (CIs): 0.03-0.48, p = 0.028), grade 3 disease (beta-Coefficient: 0.28, 95% CIs: 0.03-0.52, p = 0.026), and estrogen receptor (ER) score (beta-Coefficient: -0.14, 95% CIs: -0.22--0.06, p = 0.001) all independently predicted RS, with AUC of 0.719. Using multivariable regression analyses, grade 3 disease (odds ratio (OR): 5.67, 95% CIs: 1.32-40.00, p = 0.037), decreased ER score (OR: 1.33, 95% CIs: 1.02-1.66, p = 0.050) and decreased progesterone receptor score (OR: 1.16, 95% CIs: 1.06-1.25, p = 0.002) all independently predicted RS > 25, with AUC of 0.740 for the static and dynamic online nomogram model. Conclusions: This study designed and validated an online user-friendly nomogram from routinely available clinicopathological parameters capable of predicting outcomes of the 21-gene RS expression assay.