{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:10:35Z","timestamp":1780657835134,"version":"3.54.1"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K12AR084231"],"award-info":[{"award-number":["K12AR084231"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30CA014236"],"award-info":[{"award-number":["P30CA014236"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2026,2,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contemporary breast cancer staging incorporates anatomic and biologic factors. Although a low (&lt;11) Oncotype Recurrence Score (RS) is linked to favorable survival, it is unclear if RS alone justifies downstaging to pathologic prognostic stage (PPS) IA. This study evaluated whether a low RS equates prognostically to PPS IA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients (18\u201375 years) with pT1\u20133\/pN0\u20131\/M0, hormone receptor\u2013positive, HER2\u2010negative unilateral invasive breast cancer, diagnosed between 2010 and 2018 were identified from the National Cancer Database. Patients receiving neoadjuvant therapy or lacking RS data were excluded. Patients were grouped by PPS, with overall survival (OS) estimated using Kaplan\u2013Meier and adjusted with Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 231,031 patients, 23.8% had RS\u00a0&lt;\u00a011, 36.6% had RS 11\u201317, 25.8% had RS 18\u201325, and 13.8% had RS\u00a0&gt;\u00a025. Median follow up was 58.9 months. Most with RS\u00a0&lt;\u00a011 were PPS IA (94.2%), yet OS declined with higher stage (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Adjusted analyses showed worse OS for higher stages within RS\u00a0&lt;\u00a011 (IB: HR 1.66 [95% CI, 1.34\u20132.05]; IIA: HR 2.29 [1.44\u20133.65]; IIB: HR 2.48 [1.03\u20135.95]). In the RS 11\u201317 group, 90.8% were PPS IA. Five\u2010year OS varied (IA: 97.8%, IB: 95.8%, IIA: 95.2%, IIB: 93.7%, IIIA: 100%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Adjusted OS differences persisted (IB: HR 1.51 [1.32\u20131.73]; IIA: HR 1.32 [1.01\u20131.72]; IIB: HR 1.58 [0.95\u20132.63]; IIIA: HR 1.44 (0.21\u20139.95]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prognostic stage significantly influences survival among patients with low RS. RS\u00a0&lt;\u00a011 alone should not automatically downstage patients to PPS IA; anatomic and other nongenomic factors remain important for prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70305","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T07:25:21Z","timestamp":1771053921000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Breast cancer staging for patients with \u201clow\u2010risk\u201d disease: Are they all the same?"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1607-8227","authenticated-orcid":false,"given":"Tori C.","family":"Nierenberg","sequence":"first","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha M.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Bioinformatics Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellery H.","family":"Reason","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra J.","family":"Modell Parrish","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Botty van den Bruele","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Chiba","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie L.","family":"DiNome","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah E.","family":"Woriax","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Shelley","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly E.","family":"Westbrook","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7411-0558","authenticated-orcid":false,"given":"Jennifer K.","family":"Plichta","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"},{"name":"Department of Population Health Sciences Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"e_1_2_9_2_1","article-title":"All Races, Females by SEER Combined Summary Stage","volume":"22","author":"SEER 22 (Excluding IL\/MA) 2014\u20132020","year":"2020","journal-title":"Secondary SEER"},{"key":"e_1_2_9_3_1","volume-title":"AJCC Cancer Staging Manual","author":"Publishing SI","year":"2016"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa041588"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1470\u20102045(09)70314\u20106"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1804710"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2108873"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab095"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010022\u201012225\u20105"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35525"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1586\/era.12.174"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.4298"},{"key":"e_1_2_9_13_1","article-title":"Anatomy and breast cancer staging: is it still relevant?","volume":"27","author":"Jennifer K","year":"2018","journal-title":"Surg Oncol Clin N Am"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12920\u2010015\u20100129\u20106"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078\u20100432.ccr\u201023\u20102436"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1602253"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.20.00853"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549\u2010022\u201006764\u20104"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.70305","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.70305","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.70305","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T10:32:24Z","timestamp":1780655544000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.70305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,2,15]]}},"alternative-id":["10.1002\/cncr.70305"],"URL":"https:\/\/doi.org\/10.1002\/cncr.70305","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]},"assertion":[{"value":"2025-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70305"}}