Background: Oncotype DX (ODX) is widely used to estimate recurrence risk and guide adjuvant therapy in hormone receptor-positive (HR+), HER2-negative early-stage breast cancer. However, limited accessibility and high costs have prompted the use of alternative clinical models, such as the Tennessee nomogram. This study aimed to validate the predictive performance of the Tennessee nomogram in a Korean breast cancer cohort and identify factors contributing to discrepancies between nomogram predictions and ODX results. Methods: We retrospectively analyzed data on1298 patients with HR+/HER2−, node-negative invasive breast cancer who underwent ODX testing between May 2013 and August 2023. Predictive probabilities were calculated using the Tennessee nomogram and compared with actual ODX recurrence scores. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were determined. Discordant cases were examined for clinicopathologic characteristics contributing to prediction errors. Results: The nomogram demonstrated an overall accuracy of 86.1% (sensitivity 0.130, specificity 0.989, AUC 0.776). Discordant results were observed in 13.9% of cases, primarily in patients with a high histologic grade, PR negativity, and elevated Ki-67 index. Most false negatives clustered within the ODX score range of 25–30, suggesting underestimation of risk in borderline-high cases. Conclusions: The Tennessee nomogram may be a useful surrogate when ODX testing is unavailable, but caution is warranted in patients with aggressive tumor biology. In such cases, ODX testing should be prioritized to guide adjuvant therapy decisions.
背景：Oncotype DX（ODX）被广泛用于评估激素受体阳性（HR+）、HER2阴性早期乳腺癌的复发风险并指导辅助治疗。然而，其可及性有限且成本高昂，促使人们使用替代临床模型，如田纳西列线图。本研究旨在验证田纳西列线图在韩国乳腺癌队列中的预测性能，并确定导致列线图预测与ODX结果之间差异的因素。 方法：我们回顾性分析了2013年5月至2023年8月期间接受ODX检测的1298例HR+/HER2-、淋巴结阴性浸润性乳腺癌患者的数据。使用田纳西列线图计算预测概率，并与实际ODX复发评分进行比较。计算了敏感性、特异性、准确性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。对结果不一致的病例进行了分析，以探究导致预测误差的临床病理特征。 结果：该列线图总体准确率为86.1%（敏感性0.130，特异性0.989，AUC 0.776）。13.9%的病例观察到结果不一致，主要出现在组织学分级高、孕激素受体（PR）阴性以及Ki-67指数升高的患者中。大多数假阴性结果集中在ODX评分25-30的范围内，提示对临界高风险病例的风险存在低估。 结论：当无法进行ODX检测时，田纳西列线图可能是一个有用的替代工具，但对于具有侵袭性肿瘤生物学特征的患者需谨慎。在此类情况下，应优先考虑进行ODX检测以指导辅助治疗决策。
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