SRS134 - Evaluating the impact of age on 21-gene recurrence score results—a systematic review and meta-analysis

Abstract Introduction The Oncotype DX Recurrence Score (RS) is a prognostic tool which predicts chemotherapy benefit and recurrence in early-stage, hormone-sensitive breast cancer. While elderly women are more likely to develop and succumb to the disease, they are less likely to tolerate systemic therapies, potentially suggesting a lower yield for RS testing in this cohort. Despite this, age-specific RS testing guidance is sparse in current clinical guidelines. Aims To assess the uptake, distribution and clinical benefit of RS testing across age groups to delineate whether an elderly patient subset consistently receives low-utility testing that does not inform clinical decisions. Methods Systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. RCTs and cohort studies reporting comparative data on RS uptake, score distribution and chemotherapy use after testing across age groups (<50 years, 50–69 years, and >70 years) were eligible for inclusion. Results Overall, 271 716 patients were included across 8 studies. Elderly patients were significantly less likely to undergo RS testing compared to younger patients (<50 years: RR = 0.61, P = 0.00815; 50–69 years: RR = 0.67, P = 0.0018). Additionally, elderly patients were more likely to have a low-risk RS result (<50 years: RR = 1.55, P = 0.001; 50–69 years: RR = 1.31, P = 0.0325) and less likely to receive chemotherapy on the basis of a high risk RS result (<50 years: RR = 0.61, P = 0.00255; 50–69 years: RR = 0.70, P = 0.00161) compared to younger counterparts. Conclusions Patients >70 years were more likely to undergo RS testing that did not impact treatment decisions, underscoring the need for further guidance on age-specific RS testing in contemporary surgical practice.