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Purpose The 21-gene (Oncotype DX) recurrence score (RS) assay is useful in predicting the benefitsof adjuvant chemotherapy for early breast cancer patients and is widely used in Westerncountries. However, to date, it has not gained much popularity in East Asia. We analyzedthe results from five institutions’ experience from using the 21-gene assay and examinedthe impact of assay results on decision making of chemotherapy in Korean breast cancerpatients and the associations between RS and clinicopathologic characteristics. Materials and MethodsThe 21-gene assay was performed on 212 patients with estrogen receptor-positive earlybreast cancer in five institutions. Each center made systemic treatment decisions bothbefore and after the knowledge of assay results. ResultsAmong the 212 patients, 132 (62.3%) had a low RS of < 18, 60 (28.3%) had an intermediateRS of 18-30, and 20 (9.4%) had a high RS of ! 31. Histologic grade, presence ofmicrometastases, Ki-67, and presence of lymphatic invasion were statistically associatedwith the RS results. Treatment decisions were changed in 115 of 212 patients (54.2%) in109 of 212 (51.4%) from chemotherapy plus hormone therapy to hormone therapy, and insix of 212 (2.8%) from hormone therapy to chemotherapy plus hormone therapy. ConclusionThe 21-gene breast cancer assay proved to have a significant impact on treatment decision-making. The test reduces chemotherapy use in more than 50% of Korean estrogenreceptor-positive, early breast cancer patients.

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