PURPOSE To examine (1) the trend and associated factors of Oncotype DX (ODX) use among hormone receptor-positive (HR+) breast cancer (BC) patients in 2004-2015; (2) the trend of reported chemotherapy by Recurrence Score (RS); and (3) the survival differences associated with ODX use. METHODS ODX data from Genomic Health Inc. were linked with 17 SEER registries data. HR + BC cases with lymph node negative (N0) or 1-3 positive LNs (N1) from 2004-2015 were analyzed. The Cochrane-Armitage trend test, logistic regression, Kaplan-Meier survival curve, and stratified Cox model were performed. Survival analysis was restricted to HR+/HER2- patients from 2010 to 2014, matched on propensity score. RESULTS ODX use increased substantially from 2004 to 2015 (N0: 2.0% to 42.7%; N1: 0.3% to 27.9%). Non-Hispanic black and Medicaid insured patients had lower odds of receiving ODX. N0 patients with moderately differentiated or 2.1-5.0 cm tumor and N1 patients with well-differentiated or < 2.0 cm tumor had higher odds of using ODX. The reported chemotherapy use decreased significantly with low and intermediate RS, and increased for high RS among N0 patients. ODX use was associated with better breast cancer-specific survival [hazard ratio (95% CI) N0 1.96 (1.60-2.41), N1 1.90 (1.42-2.54)] and overall survival [N0 2.06 (1.83-2.31), N1 1.72 (1.42-2.09)], especially in the first 36 months. CONCLUSION ODX use has increased significantly since 2004, nonetheless disparities remain, especially for racial/ethnic minorities and Medicaid insured patients. Administering chemotherapy based on ODX results has been improved among N0 patients. Patients receiving ODX had better survival than those not.

中文翻译：

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2004-2015 年，17 个 SEER 登记处女性激素受体阳性乳腺癌患者使用 Oncotype DX 的趋势和生存获益。

目的检查 (1) 2004-2015 年激素受体阳性 (HR+) 乳腺癌 (BC) 患者使用 Oncotype DX (ODX) 的趋势和相关因素；（2）Recurrence Score（RS）报告化疗的趋势；(3) 与 ODX 使用相关的生存差异。方法 来自 Genomic Health Inc. 的 ODX 数据与 17 个 SEER 注册数据相关联。分析了 2004-2015 年淋巴结阴性 (N0) 或 1-3 个阳性淋巴结 (N1) 的 HR + BC 病例。进行了 Cochrane-Armitage 趋势检验、逻辑回归、Kaplan-Meier 生存曲线和分层 Cox 模型。生存分析仅限于 2010 年至 2014 年的 HR+/HER2- 患者，与倾向评分匹配。结果 ODX 使用量从 2004 年到 2015 年大幅增加（N0：2.0% 到 42.7%；N1：0.3% 到 27.9%）。非西班牙裔黑人和医疗补助保险的患者接受 ODX 的几率较低。中度分化或 2.1-5.0 cm 肿瘤的 N0 患者和分化良好或 < 2.0 cm 肿瘤的 N1 患者使用 ODX 的几率更高。报告的化疗使用在低和中等 RS 时显着减少，而在 N0 患者中高 RS 时增加。ODX 的使用与更好的乳腺癌特异性生存率 [风险比 (95% CI) N0 1.96 (1.60-2.41)，N1 1.90 (1.42-2.54)] 和总生存率 [N0 2.06 (1.83-2.31)，N1 1.72 ( 1.42-2.09)]，尤其是在前 36 个月。结论 自 2004 年以来，ODX 的使用显着增加，但仍然存在差异，特别是对于种族/少数民族和医疗补助保险的患者。在 N0 患者中，基于 ODX 结果的化疗得到改善。