EARLY BREAST CANCER RH + / HER2-: MAGEE SCORE AND TENNESSEE NOMO-GRAM AS SURROGATES OF GENOMIC TOOL ONCOTYPE DX: EXPERIENCE IN A BRAZILIAN CANCER CENTER

Introduction: Appropriate selection of adjuvant systemic therapy in early breast cancer RH + / HER2- is classically based on clinical and anatomopathological factors, and recently genomic tests such as Oncotype Dxâ (ODXâ) and Mammaprintâ had refined these decision, mainly avoiding chemotherapy overtreatment. Regarding to ODXâ, some tools were developed in order to parallel the results using routinely available information of pathological reports. Magee score is a prediction model obtained by multiple linear regression analysis, considering Nottingham score, hormone receptor frequency and intensity in neoplastic cells, HER2 status, KI67, and tumor size. Tennessee nomogram was developed based on clinicopathological characteristics such as age, histological type, tumor size and grade and RP status, with a 86.8% concordance in defining low and high risk recurrence scores (0 to 25 and 26 to 100, respectively). Objective: To observe the correlation between ODXâ recurrence score (RS) with Magee score and Tennessee nomogram in 83 women with ER+/ HER2- early breast cancer treated at a Cancer Center in Brazil. Results: Eighty-three patients with ER + / HER2- early breast cancer who underwent ODXâ were studied. The median age was 53.5 years (24 -77 years), 59% were postmenopausal, 74.7% clinical stage I, with a median tumor size of 1.4cm (0.6-4, 0cm). For ODXâ, RS between 0 to 15 was present in 51.8%, 36.1% from 16 to 25 and 12% higher than 26. The discordance between RS ODXâ and Magee score occurred in 41.5% of the cases (risk groups: low (0-15), intermediate (16-25) and high (26-100), 8.5% if grouped in low-intermediate risk (0-25) and high risk(26-100). In one case (2.5%), there was a two-step discordance, with a low-risk Magee score being at high risk in the ODXâ . The sensitivity of the Magee test, in relation to RS of ODXâ, considering low-intermediate (0-25) and high risk (26-100) was 100%, with specificity of 30% and accuracy of 91%. Regarding Tennessee nomogram, there was discordance with RS ODXâ in 8.4% in low risk group(0-25) and 67% in high risk group(26-100). The sensitivity of Tennessee nomogram was 89%, specificity of 40% and accuracy of 83%. Conclusions: Tools such as Magee score and Tennessee nomogram may be useful in therapeutic decision-making when ODXâ is not available. In our experience the results provided by these tools can be strongly considered if they result in low risk for Tennesse nomogram and low-intermediate risk for the Magee score.