Nomogram for Predicting the Risk of Local Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ

Rudloff, Udo; Jacks, Lindsay M.; Goldberg, Jessica; Wynveen, Christine A.; Brogi, Edi; Patil, Sujata; Zee, Kimberly J. Van

doi:10.1200/jco.2009.26.8847

Cited by 287 publications

(178 citation statements)

References 66 publications

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“…The nomogram integrates 10 clinical and pathological variables: age at diagnosis, family history, initial presentation, adjuvant RT, adjuvant endocrine therapy, nuclear grade, presence of necrosis, margin size, number of re-excisions, and the time period of surgery. The study shows good internal validation and is a potentially very useful tool in predicting risk in individual patients to help guide surgical planning [71].…”

Section: Guides For Therapymentioning

confidence: 99%

Breast conserving therapy for DCIS—Does size matter?

Kantor

Winchester

2014

Journal of Surgical Oncology

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Section: Guides For Therapymentioning

confidence: 99%

Breast conserving therapy for DCIS—Does size matter?

Kantor

Winchester

2014

Journal of Surgical Oncology

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“…Online (C-index, 0.56 to 0.61), 31 Oncotype DX (C-index, 0.69), 31 and the recently published nomogram from the Memorial Sloan-Kettering Cancer Center that predicts the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ (C-index, 0.69). 26 Another limitation is that endocrine therapy data were not available and were therefore not included in the nomogram. Treatment with endocrine therapy could be a confounder, because it has been shown to reduce local recurrence risk by approximately half.…”

Section: -29mentioning

confidence: 99%

Nomogram to Predict the Benefit of Radiation for Older Patients With Breast Cancer Treated With Conservative Surgery

Albert

Liu

Shen

et al. 2012

JCO

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A B S T R A C T PurposeThe role of radiation therapy (RT) after conservative surgery (CS) remains controversial for older patients with breast cancer. Guidelines based on recent clinical trials have suggested that RT may be omitted in selected patients with favorable disease. However, it is not known whether this recommendation should extend to other older women. Accordingly, we developed a nomogram to predict the likelihood of long-term breast preservation with and without RT. MethodsWe used Surveillance, Epidemiology, and End Results-Medicare data to identify 16,092 women age 66 to 79 years treated with CS between 1992 and 2002, using claims to identify receipt of RT and subsequent mastectomy. Time to mastectomy was estimated using the Kaplan-Meier method. Cox proportional hazards models determined the effect of covariates on mastectomy-free survival (MFS). A nomogram was developed to predict 5-and 10-year MFS, given associated risk factors, and bootstrap validation was performed. ResultsWith a median follow-up of 7.2 years, the overall 5-and 10-year MFS rates were 98.1% (95% CI, 97.8% to 98.3%) and 95.4% (95% CI, 94.9% to 95.8%), respectively. In multivariate analysis, age, race, tumor size, estrogen receptor status, and receipt of RT were predictive of time to mastectomy and were incorporated into the nomogram. Nodal status was also included given a significant interaction with RT. The resulting nomogram demonstrated good accuracy in predicting MFS, with a bootstrap-corrected concordance index of 0.66. ConclusionThis clinically useful tool predicts 5-and 10-year MFS among older women with early breast cancer using readily available clinicopathologic factors and can aid individualized clinical decision making by estimating predicted benefit from RT.

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“…Predictive accuracy was corrected for overfit ("optimism") by bootstrap resampling with 200 replications, wherein the predictors were reselected within each replication. We considered an AUC of greater than 0.7 as "good" (20)(21)(22). Bootstrap resampling provides an estimate of the statistical optimism associated with evaluating a prediction model on the same dataset that was used to develop it.…”

Section: Statistical Analysesmentioning

confidence: 99%