Oncotype DX - is node status factored into the score?

mellee

I know that Oncotype has been validated for use in women with 1-3 positive nodes, but what I'm wondering is if that is somehow weighted in the score you get.

Or do they simply score you based on your tumor's genetic markers?

With Mammaprint, it is not a factor in the result. The finding of low or high risk is based solely on biomarkers. They give different recurrence rates based on nodal status, though.

mellee

Anyone have any insight? Anyone who took the test?

BarredOwl

Hi mellee:

I did not receive the test.

My layperson's understanding, which could be wrong, is that the OncotypeDX test for invasive disease ("21-gene test") determines the mRNA levels of 16 cancer-related genes and 5 control genes in the sample, and the uses a computer algorithm to calculate the Recurrence Score from mRNA levels alone, without regard to lymph node status.

The prognostic information in the reports is derived from different clinical studies which included either node-negative patients in the node-negative report, or node-positive patients in the node-positive reports.

The above interpretation makes sense in light of the instructions on the Requisition Form for the test found here:

http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/Ordering/InstructionsGuidelines

In discussing Section II, Node status, the instructions below provide:

"*Node Status: Enter the node status for the patient in the designated area. The node status is required to determine the extent of the clinical experience information to be included in the report for your patient. If the node status is not provided, a report with clinical experience for both node negative and node positive specimens will be sent. Additionally, the node status may be required for payor coverage determinations. If the node status is not specified, GHI may use the pathology report, if provided, to determine the node status for reimbursement purposes."

In other words, if the nodal status is not provided, they can still generate a Recurrence Score, but the report will include clinical information / experience pertinent to node-negative and node-positive situations.

Please confirm it with your team as necessary.

BarredOwl

mellee

Thanks, BarredOwl. That's what I assumed, but it's good to have the confirmation. Thanks for your research!

Amapola, I thought that, by and large, micromets are considered node positive. I had 1 macro node, 1 micro and all my docs counted that as 2 positive nodes. But I do know that micro is better in terms of recurrence risk. I'm so sorry that you still had to do chemo despite the low Oncotype. What a bummer! Hoping it isn't too bad for you.

cookiegal

ok, your node status does not impact your score

however the chart interpreting what that score means statistically (the report) is different for node positive

(unless something has changed dramatically, recently)

mellee

Thanks for confirming, cookiegal. That's my understanding as well.