Nomogram for accurate prediction of breast and axillary pathologic response after neoadjuvant chemotherapy in node positive patients with breast cancer

Abstract

Purpose Many patients with cytology proven node-positive breast cancer receive a neoadjuvant chemotherapy (NAC) treatment. We developed a nomogram to predict the breast and axillary pathologic complete responses (pCR) in patients with a cytologically proven axillary node positive breast cancer with NAC. Methods We selected 995 patients who were diagnosed with an invasive breast cancer and axillary lymph nodes metastasis, and who were treated with NAC followed by a curative surgery at the Samsung Medical Center between January 2007 and December 2014. The baseline patient and tumor characteristics, chemotherapy regimen, and tumor and nodal responses were thoroughly analyzed and reviewed. A nomogram was developed using a binary logistic regression model with a cross validation. Results Axillary pCR was achieved in 47.3% and breast pCR was achieved in 24.3% of the patients after NAC. In this case, the both pCR was associated with an initial clinical tumor stage, negative progesterone receptor status, positive human epidermal growth factor receptor 2 status, and clinical radiologic nodal responses. A nomogram was developed based on the clinical and statistically significant predictors. It had good discrimination performance (area under the curve [AUC], 0.868; 95% confidence interval, 0.84–0.89) and calibration fit as noted in that case. The cross validation had an average AUC 0.853 (0.837–0.869). Conclusion Our nomogram might help to predict breast and axillary pCRs after NAC in patients with an initially node-positive breast cancer. Minimal surgery might be acceptable in patients for whom the nomogram indicates a high probability of achieving pCRs.

<p>The Evaluation of Magee Equation 2 in Predicting Response and Outcome in Hormone Receptor-Positive and HER2-Negative Breast Cancer Patients Receiving Neoadjuvant Chemotherapy</p>

“…23 Several clinicopathological parameters were reported to be the predictors for response to NAC. 24,25 Luminal breast cancer subtype had lower response to NAC when compare to other subtypes. 26,27 Although there were higher proportion of T4 breast cancer recruited in this current study, the rate of pCR in the current study was similar to the recent report of clinically node-positive breast cancer receiving NAC.…”

Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer

“…It is unlikely that reverting to more radical surgery in these patients will overcome the challenges of its poorer prognosis, as comparisons of breast‐conserving therapy versus mastectomy, and wider versus narrower margins in the most biologically aggressive triple‐negative breast cancers have demonstrated no difference in locoregional recurrence according to type of surgery performed. Patients with ER+PgR– disease should, however, be considered for more aggressive neoadjuvant or adjuvant therapy, including systemic chemotherapy.…”

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

“…During follow-up, chemotherapy and hormonal therapy were used as adjuvant treatment. Some of the above-mentioned factors (associated in situ carcinoma, LVI, high histological grade, high ki 67% and progesterone receptor negative) are typical factors known to be related to local relapse [27][28][29][30].…”