A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy

Lim, Young‐Jun; Lee, Sea Won; Choi, Nam Kyong; Kwon, Junhyun; Eom, Keun Yong; Kang, Eunyoung; Kim, Eun Kyu; Kim, Jee Hyun; Kim, Yu Jung; Kim, Se Hyun; Park, So Yeon; Kim, In Ah

doi:10.4143/crt.2017.508

Cited by 15 publications

(21 citation statements)

References 28 publications

(28 reference statements)

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“…The other patient, a 34-year-old female patient with invasive ductal carcinoma, had locoregional recurrence at the surgical wound site, the subtype was triple negative, and the Ki-67 positive rate was 80%-90%. She was considered a patient with a high risk of recurrence because of her age, subtype, and Ki-67 positive rate (11,12). Although we prescribe boost irradiation with electron beam only for patients with positive or close surgical margins, the boost irradiation may prevent recurrence in these high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Advantage of Chest-wall Post-mastectomy Radiation Therapy Without Bolus

Shiba

Okamoto

Kiyohara

et al. 2018

In Vivo

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Abstract. Background Post-mastectomy radiation therapy (PMRT) improves local control and survival in patients with breast cancer with a high risk of recurrence (those with advanced tumor and/or multiple lymph node metastases). PMRT reduces locoregional and distant recurrence in patients with axillary dissection and in those with axillary sampling, and radiation dermatitis is its most problematic adverse event (1). Almost all reports have used a bolus to maximize the radiation dose for the chest-wall surface and to decrease the risk of local recurrence, disregarding the radiation dermatitis problem (2). However, the use of a bolus has been reported to increase the frequency of severe radiation dermatitis (3). Few reports have compared the clinical outcomes of PMRT between patients using a bolus and those not using one, and no reports have analyzed the chest-wall dose surface histogram (DSH) parameters for PMRT. Therefore, a retrospective analysis of clinical outcomes in PMRTs without bolus was conducted and the DSH parameters between irradiation plans with and without virtual boluses were compared. Patients and MethodsPatients. Between October 2011 and December 2016, 55 patients with breast cancer received PMRT at the Gunma University Hospital. Among these patients, three who received boost irradiation with electron beams were excluded because of the difficulty in recreating the precise dose distribution of electron beams using our radiation treatment planning system (RTPS) of the XiO version 4.5 software (ELEKTA, Stockholm, Sweden). Thus, 52 patients with breast cancer who received PMRT were retrospectively analyzed, and all patients were treated with 6 MV X-ray beams without bolus. Patient characteristics are summarized in Table I. Histologically, 46 patients had invasive ductal carcinoma, three had invasive lobular carcinoma, and four had other breast cancer types. Breast cancer subtypes were defined according to the status of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), and the Ki-67 index. Twenty-four patients had luminal A (ER-positive and/or PgR-positive, HER2-negative, and Ki-67 <20%), 20 had luminal B (luminal type other than luminal A), four had HER2-enriched (ER-negative, PgR-negative, and HER2-positive), and four had triple-negative (ER-negative, PgRnegative, and HER2-negative) cancer subtypes. Twelve patients had 961

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Section: Discussionmentioning

confidence: 99%

Clinical Advantage of Chest-wall Post-mastectomy Radiation Therapy Without Bolus

Shiba

Okamoto

Kiyohara

et al. 2018

In Vivo

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“…A nomogram is a graphical calculating model constructed with known prognostic factors that generates a numerical probability of a clinical event [ 19 ]. In breast cancer, nomograms have been widely used as a prediction model to predict specific outcomes (such as disease recurrence and distant metastasis) [ 20 , 21 ]. Our study aimed to study trend of mortality risk in MBC and construct a nomogram to quantifying the survival probability of breast cancer patients with distant metastasis.…”

Section: Introductionmentioning

confidence: 99%

Score for the Survival Probability in Metastasis Breast Cancer: A Nomogram-Based Risk Assessment Model

et al. 2018

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PurposeSurvival of metastatic breast cancer (MBC) patient remains unknown and varies greatly from person to person. Thus, we aimed to construct a nomogram to quantify the survival probability of patients with MBC.Materials and MethodsWe had included 793 MBC patients and calculated trends of case fatality rate by Kaplan-Meier method and joinpoint regression. Six hundred thirty-four patients with MBC between January 2004 and July 2011 and 159 patients with MBC between August 2011 and July 2013 were assigned to training cohort and internal validation cohort, respectively. We constructed the nomogram based on the results of univariable and multivariable Cox regression analyses in the training cohort and validated the nomogram in the validation cohort. Concordance index and calibration curves were used to assess the effectiveness of nomogram.ResultsCase fatality rate of MBC was increasing (annual percentage change [APC], 21.6; 95% confidence interval [CI], 1.0 to 46.3; p < 0.05) in the first 18 months and then decreased (APC, -4.5; 95% CI, -8.2 to -0.7; p < 0.05). Metastasis-free interval, age, metastasis location, and hormone receptor status were independent prognostic factors and were included in the nomogram, which had a concordance index of 0.69 in the training cohort and 0.67 in the validation cohort. Calibration curves indicated good consistency between the two cohorts at 1 and 3 years.ConclusionIn conclusion, the fatality risk of MBC was increasing and reached the summit between 13th and 18th month after the detection of MBC. We have developed and validated a nomogram to predict the 1- and 3-year survival probability in MBC.

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“…In present, the nomogram, as a weighted model, is widely used in oncology to improve decision making and accurately predict the potential interaction because of its visual advantages among predictors and enable an evaluation of the extent of the impact of each predictor on the probability of survival [23]. Ki-67 was highly signi cant in our analysis which has been correlated with survival reproducibly among patients in several large studies, followed by Young's modulus and strain ratio.…”

Section: Discussionmentioning

confidence: 76%

Combination of ultrasonic elastography and Ki-67 index as a novel predictive modality for the prognosis in clinic stage III breast cancer

Shu²,

Chen

et al. 2019

Preprint

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Background To investigate the feasibility of combination of ultrasonic elastography (UE) and Ki-67 index as a novel predictive modality for the prognosis of clinic stage Ⅲ breast cancer. Methods Of 112 patients, Multi-parameter of UE were obtained after analyzing elastograms of 112 lesions which were recorded classification of Ki-67 by histopathologic diagnosis. Multivariate Survival analysis was performed by using multivariate Cox model. The nomograms was established to predict the probability of clinic stage Ⅲ breast cancer according to the selected independently significant variables in the multivariate Cox model. The model was internally validated using Harrell’s concordance index. Results ⅢC had significant difference in all ultrasonic elastography (UE) parameters (P < 0.05) and were statistically different from ⅢA and ⅢB (P < 0.01). The Cox model was RR (t)= Exp(1.104* X1+0.901*X4+0.972*X5) (X1: classification of Ki-67, X4: classification of strain ratio, X5: classification of Young's modulus). The nomogram showed that Ki-67 had the greatest influence on survival prediction, followed by Young's modulus and strain ratio. Internal validation revealed a concordance index of 0.76. Conclusions Our study explored a novel modality in predicting the prognosis of clinic stage Ⅲ breast cancer combining a tumor marker with breast UE imaging. A nomogram was developed to prove that the model was helpful to estimate the 5-year survival of the patients.

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A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy

Cited by 15 publications

References 28 publications

Clinical Advantage of Chest-wall Post-mastectomy Radiation Therapy Without Bolus

Clinical Advantage of Chest-wall Post-mastectomy Radiation Therapy Without Bolus

Score for the Survival Probability in Metastasis Breast Cancer: A Nomogram-Based Risk Assessment Model

Combination of ultrasonic elastography and Ki-67 index as a novel predictive modality for the prognosis in clinic stage III breast cancer

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