Construction and Validation of a Serum Albumin-to-Alkaline Phosphatase Ratio-Based Nomogram for Predicting Pathological Complete Response in Breast Cancer

Qu, Fanli; Li, Zongyan; Lai, Shengqing; Zhong, Xiaofang; Fu, Xiaoyan; Huang, Xiaojia; Li, Qian; Liu, Shengchun; Li, Haiyan

doi:10.3389/fonc.2021.681905

Cited by 10 publications

(9 citation statements)

References 51 publications

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“…concluded that BMI was not a predictive biomarker for pCR, which was similar to the result of our study ( 48 ). Furthermore, our study confirmed that tumor makers, axillary LN positive, menstrual status before NACT ( 49 ), and albumin levels ( 50 ) did not show significant values in predicting PCR, which was consistent with previous studies.…”

Section: Discussionsupporting

confidence: 92%

Individualized model for predicting pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: A multicenter study

Qian

Yang²,

Zhou³

et al. 2022

Front. Endocrinol.

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BackgroundPathological complete response (pCR) is considered a surrogate for favorable survival in breast cancer (BC) patients treated with neoadjuvant chemotherapy (NACT), which is the goal of NACT. This study aimed to develop and validate a nomogram for predicting the pCR probability of BC patients after NACT based on the clinicopathological features.MethodsA retrospective analysis of 527 BC patients treated with NACT between January 2018 and December 2021 from two institutions was conducted. Univariate and multivariate logistic regression analyses were performed to select the most useful predictors from the training cohort (n = 225), and then a nomogram model was developed. The performance of the nomogram was evaluated with respect to its discrimination, calibration, and clinical usefulness. Internal validation and external validation were performed in an independent validation cohort of 96 and 205 consecutive BC patients, respectively.ResultsAmong the 18 clinicopathological features, five variables were selected to develop the prediction model, including age, American Joint Committee on Cancer (AJCC) T stage, Ki67 index before NACT, human epidermal growth factor receptor 2 (HER2), and hormone receptor (HR) status. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.825 (95% CI, 0.772 to 0.878) in the training cohort, and 0.755 (95% CI, 0.658 to 0.851) and 0.79 (95% CI, 0.724 to 0.856) in the internal and external validation cohorts, respectively. The calibration curve presented good agreement between prediction by nomogram and actual observation, and decision curve analysis (DCA) indicated that the nomogram had good net benefits in clinical scenarios.ConclusionThis study constructed a validated nomogram based on age, AJCC T stage, Ki67 index before NACT, HER2, and HR status, which could be non-invasively applied to personalize the prediction of pCR in BC patients treated with NACT.

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Section: Discussionsupporting

confidence: 92%

Individualized model for predicting pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: A multicenter study

Qian

Yang²,

Zhou³

et al. 2022

Front. Endocrinol.

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“…Breast cancer (BC) is the most common female malignancy worldwide and is one of the leading causes of morbidity and mortality. [1][2][3] Metastases, especially bone metastases, play an important role. 4,5 With the continuous improvement of early diagnostic methods and comprehensive treatments, the survival of BC has significantly increased.…”

Section: Introductionmentioning

confidence: 99%

“…4 Alkaline phosphatase (ALP) is a nonspecific enzyme that hydrolyzes phosphate in alkaline medium and its total level reflects the combined activity of several isozymes found in the bone, liver, kidney, and intestinal lining. 1,7 Its bone-specific isoforms (bone-specific alkaline phosphatase, BAP) originates in osteoblasts that release large amounts of the enzyme when bone repair activity occurs, for example bone metastases. 8,9 In the last few decades, hundreds of studies have reported the clinical value of ALP/BAP in BC and a significant increase in serum ALP was observed, which had been demonstrated to predict bone and liver metastases.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of alkaline phosphatase and bone-specific alkaline phosphatase in breast cancer: A systematic review and meta-analysis

Jiang

Xia

et al. 2023

Int J Biol Markers

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Numerous studies have reported the clinical value of alkaline phosphatase (ALP) and its bone-specific isoforms (bone-specific alkaline phosphatase (BAP)) in breast cancer. The purpose of this meta-analysis was to summarize the prognostic value of serum ALP and BAP in breast cancer, especially focused on bone metastasis and survival. PRISMA guidelines were followed to conduct this review. Observational studies were searched in PubMed, Cochcrane Library and EMBASE to January 1, 2022. Data were extracted to explore the prognostic value of ALP and BAP. The quality of the included studies was assessed and the outcome effects were evaluated. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity. Publication bias was assessed. There was a total of 53 studies with 22,436 patients included. For the primary outcome of survival, high levels of both ALP and BAP were associated with short survival time. The hazard ratio of high ALP level on overall survival was 1.72 (95% CI 1.37, 2.16, P < 0.001). For the secondary outcomes, a high ALP level (not BAP) was detected in breast cancer compared with healthy controls, and high levels of both ALP and BAP were risk factors for bone metastasis, while ALP (not BAP) was a risk factor for non-bone metastasis. This study showed that high levels of both serum ALP and BAP were associated with metastasis (BAP was associated with bone metastasis) and survival in breast cancer. The biomarkers could provide useful information for the early diagnostic assessment and monitoring in the follow-up of breast cancer patients.

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“…A total of three studies 32 , 33 , 56 investigated the value of albumin in predicting a pCR in breast cancer. These three studies were included in the meta-analysis, with a total of 772 patients and 162 with a pCR.…”

Section: Resultsmentioning

confidence: 99%

Predictive value of pretreatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: meta-analysis

Dowling,

Daly,

Hegarty

et al. 2024

British Journal of Surgery

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Background Systemic inflammatory response markers have been found to have a prognostic role in several cancers, but their value in predicting the response to neoadjuvant chemotherapy in breast cancer is uncertain. A systematic review and meta-analysis of the literature was carried out to investigate this. Methods A systematic search of electronic databases was conducted to identify studies that explored the predictive value of circulating systemic inflammatory response markers in patients with breast cancer before commencing neoadjuvant therapy. A meta-analysis was undertaken for each inflammatory marker where three or more studies reported pCR rates in relation to the inflammatory marker. Outcome data are reported as ORs and 95% confidence intervals. Results A total of 49 studies were included, of which 42 were suitable for meta-analysis. A lower pretreatment neutrophil-to-lymphocyte ratio was associated with an increased pCR rate (pooled OR 1.66 (95% c.i. 1.32 to 2.09); P < 0.001). A lower white cell count (OR 1.96 (95% c.i. 1.29 to 2.97); P = 0.002) and a lower monocyte count (OR 3.20 (95% c.i. 1.71 to 5.97); P < 0.001) were also associated with a pCR. A higher lymphocyte count was associated with an increased pCR rate (OR 0.44 (95% c.i. 0.30 to 0.64); P < 0.001). Conclusion The present study found the pretreatment neutrophil-to-lymphocyte ratio, white cell count, lymphocyte count, and monocyte count of value in the prediction of a pCR in the neoadjuvant treatment of breast cancer. Further research is required to determine their value in specific breast cancer subtypes and to establish optimal cut-off values, before their adoption in clinical practice.

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Construction and Validation of a Serum Albumin-to-Alkaline Phosphatase Ratio-Based Nomogram for Predicting Pathological Complete Response in Breast Cancer

Cited by 10 publications

References 51 publications

Individualized model for predicting pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: A multicenter study

Individualized model for predicting pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: A multicenter study

Prognostic value of alkaline phosphatase and bone-specific alkaline phosphatase in breast cancer: A systematic review and meta-analysis

Predictive value of pretreatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: meta-analysis

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