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To identify the relationship between clinical pathological characteristics and the recurrence score (RS) on a 21-gene expression assay in patients with hormone receptor–positive, node-negative breast cancer, as well as the effect of RS on adjuvant decision-making. The retrospective study was conducted among luminal breast cancer patients admitted to Xijing Hospital between October 10, 2016, and September 14, 2018. Real-time PCR was used for 21-genome detection. Based on the calculated RS, participants were classified into low-risk, moderate-risk, and high-risk groups. Single-factor analysis and multiple logistic regression analysis were performed to explore independent predictors of high RS. Moreover, the effect of RS on adjuvant decision-making was studied. Two hundred twenty-two patients with luminal breast cancer, aged 48.3 ± 9.66, were enrolled. Among them, 33.8% had low (13 ± 3.34), 45.5% intermediate (23 ± 3.65), and 20.7% high (37 ± 3.44) RS. According to the single-factor analysis, age, tumor size, Ki-67, molecular subtype, CK5/6 expression, E-cadherin level, and histological grade were positively associated with high RS. Multiple logistic analyses showed that tumor size and histological grade were independent variables that might predict high RS in patients with hormone receptor–positive, node-negative breast cancer. For adjuvant decision-making, the proportion of adjuvant chemotherapy in the intermediate-/high-risk groups was higher than that in the low-risk group, P < 0.001. Compared with the data worldwide, the changes of treatment selection in the present study were similar to those in Japan (23.0% vs. 26%) and America (23.0% vs. 23.0%). Considering the pathology types, 14.3% of patients with invasive breast cancer with lower RS changed treatment recommendations, predominantly from chemo-endocrine to endocrine treatment alone, whereas the percentage in intermediate/high RS groups was 8.1%. Tumor size and histological grade were independent variables, predicting high risk in patients with hormone receptor–positive, node-negative breast cancer; 21-gene RS assessment was potentially a critical tool in guiding adjuvant decision-making in China. • We enriched the data about the clinical significance of RS among Chinese patients. • Tumor size and histological grade were independent factors to 21 gene recurrence score. • 21-gene recurrence score value was promising in adjuvant decision-making for early breast cancer patients in China. [ABSTRACT FROM AUTHOR]

Naïve dialecticism refers to a set of East Asian lay beliefs characterized by tolerance for contradiction, the expectation of change, and cognitive holism. In five studies, the authors examined the cognitive mechanisms that give rise to global self-concept inconsistency among dialectical cultures. Contradictory self-knowledge was more readily available (Study 1) and simultaneously accessible (Study 2) among East Asians (Japanese and Chinese) than among Euro-Americans. East Asians also exhibited greater change and holism in the spontaneous self-concept (Study 1) and inconsistency in their implicit self-beliefs (Study 3). Cultural differences in self-concept inconsistency were obtained when controlling for alternative explanatory variables, including self-criticism (Study 4) and self-concept certainty (Studies 2 and 3) and were fully mediated by a direct measure of dialecticism (Study 5). Naïve dialecticism provides a comprehensive theoretical framework for understanding these cultural differences and the contradictory, changeable, and holistic nature of the East Asian self-concept.