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The following is a summary of “Development and Validation of the RSClinN+ Tool to Predict Prognosis and Chemotherapy Benefit for Hormone Receptor–Positive, Node-Positive Breast Cancer,” published in the December 2024 issue of Oncology by Pusztai et al.      

Clinicopathological factors and the 21-gene Oncotype DX Breast Recurrence Score (RS) test influence prognosis in people with hormone receptor-positive (HR+), HER2-negative, and node-positive breast cancer.  

Researchers conducted a retrospective study to develop and validate the RSClinN+ tool for predicting prognosis and chemotherapy benefits in people with HR+/HER2-negative, node-positive breast cancer.  

They used data from 5,283 people treated with chemoendocrine therapy (CET) vs. ET alone in the S1007 (N = 4,916) and S8814 (N = 367) clinical trials. Cox proportional hazards regression models estimated 5-year invasive disease-free survival for premenopausal and postmenopausal women. The RSClinN+ model was compared with the RS test alone and clinicopathological models using likelihood ratio tests. Validation of RSClinN+ was performed in 592 people with node-positive disease from the Clalit Health Services registry.  

The results showed that RSClinN+ provided better prognostic information than the RS model alone (premenopausal P=.034; postmenopausal P<.001) or clinicopathological models alone (premenopausal P=.002; postmenopausal P<.001). In postmenopausal women, RS interacted with CET benefit (P=.016), with RSClinN+ absolute CET benefit ranging from <0.1% to 21.5% over RS ranges 0-50. In premenopausal people with RS ≤25, with no significant interaction between RS and CET benefits. The RSClinN+ risk estimates were prognostic (HR, 1.75 [95% CI, 1.38 to 2.20]) and concordant with observed risk (Lin’s concordance, 0.92) in external validation.  

They concluded that RSClinN+ improved the prediction of prognosis and chemotherapy benefit compared to the RS test or clinicopathological data alone, supporting more personalized counseling for people with breast cancer.  

Source: ascopubs.org/doi/10.1200/JCO-24-01507