A new methodology to predict the oncotype scores based on clinico-pathological data with similar tumor profiles

Introduction: The Oncotype DX (ODX) test is a commercially available molecular test for breast cancer assay that provides prognostic and predictive breast cancer recurrence information for hormone positive, HER2-negative patients. The aim of this study is to propose a novel methodology to assist physicians in their decision-making. Methods: A retrospective study between 2012 and 2020 with 333 cases that underwent an ODX assay from three hospitals in Bourgogne Franche-Comt{\'e} was conducted. Clinical and pathological reports were used to collect the data. A methodology based on distributional random forest was developed using 9 clinico-pathological characteristics. This methodology can be used particularly to identify the patients of the training cohort that share similarities with the new patient and to predict an estimate of the distribution of the ODX score. Results: The mean age of participants id 56.9 years old. We have correctly classified 92% of patients in low risk and 40.2% of patients in high risk. The overall accuracy is 79.3%. The proportion of low risk correct predicted value (PPV) is 82%. The percentage of high risk correct predicted value (NPV) is approximately 62.3%. The F1-score and the Area Under Curve (AUC) are of 0.87 and 0.759, respectively. Conclusion: The proposed methodology makes it possible to predict the distribution of the ODX score for a patient and provides an explanation of the predicted score. The use of the methodology with the pathologist's expertise on the different histological and immunohistochemical characteristics has a clinical impact to help oncologist in decision-making regarding breast cancer therapy.