%0 Journal Article %T Impact of the 21-gene recurrence score assay on chemotherapy decision making and outcomes for breast cancer patients with four or more positive lymph nodes %A Zhang, Qing-Hong %A Zhang, Wen-Wen %A Wang, Jun %A Lian, Chen-Lu %A Sun, Jia-Yuan %A He, Zhen-Yu %A Wu, San-Gang %J Annals of Translational Medicine %D 2019 %B 2019 %9 %! Impact of the 21-gene recurrence score assay on chemotherapy decision making and outcomes for breast cancer patients with four or more positive lymph nodes %K %X Background: To assess the impact of the 21-gene recurrence score (RS) on chemotherapy decision making and survival outcomes for breast cancer patients with >4 positive lymph nodes. Methods: Patients with non-metastatic estrogen receptor-positive breast cancer with >4 positive lymph nodes diagnosed between 2004 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. The relationships between the 21-gene RS value and survival outcomes, chemotherapy decision-making, and chemotherapy benefit were analyzed. Results: A total of 410 patients were identified, including 191 (46.6%), 164 (40.0%), and 55 (13.4%) in the low-, intermediate-, and high-risk RS groups, respectively. The 21-gene RS assay results were independently related to chemotherapy receipt. A total of 59.0%, 68.0%, and 78.0% of patients received chemotherapy in the low-, intermediate-, and high-risk RS groups, respectively. The 21-gene RS was an independent indicator of breast cancer specific survival (BCSS) and overall survival (OS). Intermediate-risk [BCSS: hazards ratio (HR), 2.832, 95% confidence interval (CI): 1.160–6.910, P=0.022; OS: HR, 3.704, 95% CI: 1.750–7.836, P=0.001] and high-risk RS (BCSS: HR, 6.440, 95% CI: 2.597–15.974, P Conclusions: The 21-gene RS is an independent predictor of chemotherapy receipt and survival outcomes for breast cancer patients with > 4 positive lymph nodes. %U https://atm.amegroups.org/article/view/29264 %V 7 %N 18 %P 446 %@ 2305-5847