What does this research mean for the field?

Among women under 50 with hormone receptor-positive breast cancer and a low Oncotype DX recurrence score (≤15), the receipt of adjuvant chemotherapy is strongly driven by clinicopathologic risk factors such as higher tumor stage, poorly differentiated grade, and greater regional nodal involvement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to assess adjuvant chemotherapy (CT) patterns among premenopausal women with hormone receptor-positive breast cancer and low Oncotype DX recurrence scores.

May 29, 2026

Chemotherapy use among women < 50 years with hormone receptor–positive breast cancer with low (≤15) Oncotype DX 21-gene recurrence score: A National Cancer Database (NCDB) analysis.

Key Points

The aim is to assess adjuvant chemotherapy (CT) patterns among premenopausal women with hormone receptor-positive breast cancer and low Oncotype DX recurrence scores.
Retrospective analysis using the National Cancer Database from 2018-2022.
Included women under 50 years with stage I-III hormone receptor-positive HER2-negative breast cancer.
Multivariable binary logistic regression analyzed associations between clinical-pathological factors and CT receipt.
Out of 6040 patients with low recurrence score, only 265 (4.4%) received chemotherapy.
For patients with positive lymph nodes, older age showed lower odds of receiving CT (aOR 0.96, 95% CI 0.93-1.00, p=0.03).
Higher tumor stage and poor differentiation significantly increased odds of receiving chemotherapy, indicating significant clinical-pathological influence.

Abstract

544 Background: RxPONDER demonstrated a benefit to chemotherapy (CT) in premenopausal women with hormone receptor-positive (HR+) breast cancer (BC) with 1-3 pathological positive lymph nodes (pN1) regardless of Oncotype DX RS. Whether the benefit is due to the cytotoxic effects of CT itself or potentially from the CT-induced ovarian suppression remains to be determined. In the absence of large prospective data evaluating the predictive ability of RS in this population, including pN1mi, we sought to examine adjuvant CT use patterns among premenopausal women and low RS. Methods: This retrospective analysis queries the NCDB from 2018-2022 for patients (pts) with BC 51%) ER and PR expression (>93% of patients). Among all low RS, 5081 (84.4%) had pN0 and 939 (15.5%) had pN1 or higher disease, 704 pts (76.6%) having 1 LN involved, of which 317 pts were pN1mi; 148 (16.1%) had 2 LN and 67 (7.3%) had 3+ LN. Accounting for all pts, 265 (4.4%) received CT: 64 (24.2%) were pN0, while 201 (75.8%) were pN1+. Among pts with pN1 BC, older age was associated with lower odds of receiving adjuvant CT (aOR 0.96, 95%CI 0.93-1.00, p=0.03). Other factors including higher pathologic tumor stage (pT3/T4 vs pT1/T2; aOR 4.46, 95% CI 2.34–8.51), higher pN involvement, specifically 2 LN (aOR 2.45, 95% CI 1.60–3.75) and ≥3 LN (aOR 4.65, 95% CI 2.54–8.51) compared to 1 positive regional LN, and poorly (vs well) differentiated tumor (aOR 2.36, 95% CI 1.14–4.88) had higher odds of receiving CT. Similarly, pts with pN0 and low RS that had pT3/T4 tumors (aOR 3.99, 95% 1.16-13.72) and higher grade (moderately and poorly differentiated tumors) had higher odds of receiving CT (aOR 1.84 95% CI 1.03-3.27 and 6.11 95% CI 2.58-14.44, respectively). Conclusions: Among women <50 years with low RS (≤15), CT receipt was strongly associated with clinicopathologic risk factors, including higher tumor stage, poorly differentiated grade and higher regional nodal involvement. These findings indicate that despite a low RS, young age and node positivity are associated with adjuvant CT recommendation. These results highlight the importance of ongoing trials such as OFSET, which aims to better answer the appropriateness of CT among premenopausal women.

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