Can We Reliably Identify the Pathological Outcomes of Neoadjuvant Chemotherapy in Patients with Breast Cancer? Development and Validation of a Logistic Regression Nomogram Based on Preoperative Factors

Abstract

Background Pathological responses of neoadjuvant chemotherapy (NCT) are associated with survival outcomes in patients with breast cancer. Previous studies constructed models using out-of-date variables to predict pathological outcomes, and lacked external validation, making them unsuitable to guide current clinical practice. Objective The aim of this study was to develop and validate a nomogram to predict the objective remission rate (ORR) of NCT based on pretreatment clinicopathological variables. Methods Data from 110 patients with breast cancer who received NCT were used to establish and calibrate a nomogram for pathological outcomes based on multivariate logistic regression. The predictive performance of this model was further validated using a second cohort of 55 patients with breast cancer. Discrimination of the prediction model was assessed using an area under the receiver operating characteristic curve (AUC), and calibration was assessed using calibration plots. The diagnostic odds ratio (DOR) was calculated to further evaluate the performance of the nomogram and determine the optimal cut-off value. Results The final multivariate regression model included age, NCT cycles, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and lymphovascular invasion. A nomogram was developed as a graphical representation of the model and showed good calibration and discrimination in both sets (an AUC of 0.864 and 0.750 for the training and validation cohorts, respectively). Finally, according to the Youden index and DORs, we assigned an optimal ORR cut-off value of 0.646. Conclusion We developed a nomogram to predict the ORR of NCT in patients with breast cancer. Using the nomogram, for patients who are operable and whose ORR is < 0.646, we believe that the benefits of NCT are limited and these patients can be treated directly using surgery.

Prognostic significance of serum inflammation indexes in different Lauren classification of gastric cancer

“…The nomogram models were drawn through the R studio by "SvyNom" and "rms" packages. 18 The relationship curve and scatter plot were drawn by GraphPad Prism 8. SPSS version 25.0 (SPSS Inc., Chicago, IL, USA) was used for analysis and p < 0.05 was considered statistically significant.…”

“…Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each factor. The nomogram models were drawn through the R studio by “SvyNom” and “rms” packages 18 . The relationship curve and scatter plot were drawn by GraphPad Prism 8.…”

Nomogram-derived prediction of pathologic complete response (pCR) in breast cancer patients treated with neoadjuvant chemotherapy (NCT)

“…Combining the clinical evaluations before NCT and postoperative pathology reports, we determined whether further therapy was needed after surgery. Specific details of this process were described in our previous studies [12].…”

“…The exclusion criteria have been described in our previous study [12], which mainly included: 1. stage IV breast cancer; 2. luminal A breast cancer (luminal A subtypes exhibit lower sensitivity to chemotherapy, and hormonal therapy alone is the preferred treatment for this subtype [13]); 3. male breast cancer; 4. other types of neoadjuvant therapy, including radiotherapy and endocrine therapy. Finally, a total of 165 breast cancer patients who received NCT were included.…”

A Practical Predictive Model Based on Ultrasound Imaging and Clinical Indices for Estimation of Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer

“…Multiple models have been published predicting axillary pathological response after NACT in varying cohorts. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] Some baseline clinicopathological features and genotyping can predict the curative effect of NACT for breast cancer and further reflect the satisfied prognosis. However, the high costs associated with these genetic and molecular tests limit their utility in regular clinical practice.…”