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Association of Insulin Resistance and Higher Oncotype DX™ Recurrence Score

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Black women with breast cancer have a worse overall survival compared with White women; however, no difference in Oncotype DX™ (ODX) recurrence scores has been observed to explain this health disparity. Black women are also disproportionately affected by insulin resistance. We evaluated whether insulin resistance is associated with a higher ODX recurrence score and whether there is a difference between White and Black women to explain disparate clinical outcomes.

Methods

A subgroup analysis of patients in a multi-institutional cross-sectional study evaluating differences in insulin resistance between White and Black women was performed. Women diagnosed with a new hormone receptor-positive, HER2/neu-negative breast cancer with an ODX recurrence score were identified. Fasting blood glucose and insulin measurements were used to calculate the homeostatic model assessment of insulin resistance (HOMA-IR) score, a method for assessing insulin resistance, and compared against ODX scores.

Results

Overall, 412 women (358 White women, 54 Black women) were identified. Compared with White women, Black women had a higher body mass index (30 vs. 26 kg/m2, p < 0.0001), higher HOMA-IR score (2.4 vs. 1.4, p = 0.004), and more high-grade tumors (30% vs. 16%, p = 0.01). There was a direct positive association with an increasing ODX score and HOMA-IR (p = 0.014). On subset analysis, this relationship was seen in White women (p = 0.005), but not in Black women (p = 0.55).

Conclusion

In women with newly diagnosed breast cancer, increasing insulin resistance is associated with a higher recurrence score; however, this association was not present in Black women. This lack of association may be due to the small number of Black women in the cohort, or possibly a reflection of a different biological disease process of the patient’s tumor.

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Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute at Mount Sinai, New York, NY, USA

    Nicole T. Gordon MD, Jaime J. Alberty-Oller MD, Emily J. Gallagher MD, Derek LeRoith MD, Elisa Port MD, Amy Tiersten MD & Nina A. Bickell MD

  2. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Center for Health Equity and Community Engaged Research, New York, NY, USA

    Kezhen Fei PhD & Giampaolo Greco PhD

  3. Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Kezhen Fei PhD & Giampaolo Greco PhD

  4. Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emily J. Gallagher MD & Derek LeRoith MD

  5. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emily J. Gallagher MD, Derek LeRoith MD & Nina A. Bickell MD

  6. Department of Surgery, Montefiore Medical Center, New York, NY, USA

    Sheldon M. Feldman MD

  7. Department of Surgery, Yale School of Medicine, New Haven, CT, USA

    Bridgid Killilea MD

  8. Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA

    Susan K. Boolbol MD

  9. Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA

    Lydia Choi MD

  10. Department of Surgery, Mercy Medical Center, Baltimore, MD, USA

    Neil Friedman MD

  11. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Melissa Pilewskie MD

  12. Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Amy Tiersten MD

  13. Bakersfield, CA, USA

    Nicole T. Gordon MD

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  1. Nicole T. Gordon MD
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Corresponding author

Correspondence to Nicole T. Gordon MD.

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Disclosures

Emily Gallagher received research support from Alkeon Capital Management, and was a member of the Advisory Board for Novartis in 2019. Brigid Killelea received grant support from the sponsor (Mt. Sinai) for this study, and also received consulting fees from Genentech, which she believes is not relevant to this manuscript. Nicole T. Gordon, Jaime J. Alberty-Oller, Kezhen Fei, Giampaolo Greco, Derek LeRoith, Sheldon M. Feldman, Susan K. Boolbol, Lydia Choi, Neil Friedman, Melissa Pilewskie, Elisa Port, Amy Tiersten, and Nina A. Bickell have no disclosures to declare.

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Gordon, N.T., Alberty-Oller, J.J., Fei, K. et al. Association of Insulin Resistance and Higher Oncotype DX™ Recurrence Score. Ann Surg Oncol 28, 5941–5947 (2021). https://doi.org/10.1245/s10434-021-09748-8

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  • DOI: https://doi.org/10.1245/s10434-021-09748-8

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