Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer: A multicentre study on 1,950 patients

Abstract

Background: Type of axillary surgery in breast cancer (BC) patients who convert from cN þ to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized. Patients and methods: 1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR). Results: Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2þ (OR 3.26, p < 0.0001) or ERþ/HER2þ (OR 2.26, p ¼ 0.0002) or ER-/HER2-(OR 1.89, p ¼ 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p ¼ 0.0005), and tumor grading G2 (OR 0.35, p ¼ 0.002) or G3 (OR 0.29, p ¼ 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75e0.80). After external validation the accuracy of the nomogram was confirmed.

[Retracted] MRI Diagnosis and Pathological Examination of Axillary Lymph Node Metastasis in Breast Cancer Patients

“…Both the distribution of intravascular contrast agents and the early enhancement mode could sensitively reflect the microvascular density and specific distribution of the body [ 11 ]. It was speculated that the main mechanism was as follows: breast cancer primary tumors of hemodynamic changes would affect axillary lymph node metastasis.…”

Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving pathological complete response after neoadjuvant therapy: Is it necessary?

“…Several studies have confirmed the high correlation between breast pCR and axillary pCR. pCR in the axilla can be indirectly predicted by predicting breast pCR [ [14] , [15] , [20] ]. Especially for patients with high load such as cN2, it is very important to be able to assess the pathological response of the breast before surgery after NAT.…”

“…Although few cN2 patients were enrolled in the Z1071 study, sentinel lymph node biopsy was still feasible in this subset of patients with high axillary burden according to the results [ 13 ]. Studies have demonstrated a high correlation between axillary pCR and breast pCR in patients with cN + following NAT[ [14] , [15] ]. It is therefore hypothesized that patients with both TN and HER2-positive subtypes of cN2 who achieve pCR in their breast following NAT may be suitable candidates for undergoing only SLNB and avoiding axillary dissection.…”

Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis

“…A recent international EUBREAST survey among 349 international breast units demonstrated that standard ALND or target ALND are still the preferred approach in these patients 14 . In 2021, our group developed and validated a post-NAC predictive nomogram to select cN + BC patients with a low risk of residual axillary disease after NAC in whom axillary surgery could be minimized 15 . To date, there are no validated tools to identify, before NAC, patients who are most likely to undergo node conversion.…”