Nomograms to Predict Pathologic Complete Response and Metastasis-Free Survival After Preoperative Chemotherapy for Breast Cancer

Rouzier, Roman; Pusztai, Lajos; Delaloge, Suzette; González-Angulo, Ana M.; Hess, Kenneth R.; Buzdar, Aman U.; Garbay, Jean Rémi; Spielmann, M.; Mathieu, Marie Christine; Symmans, W. Fraser; Wagner, Peter J.; Atallah, David; Valero, Vicente; Berry, Donald A.; Hortobágyi, Gabriel N.

doi:10.1200/jco.2005.01.2898

Cited by 259 publications

(204 citation statements)

References 24 publications

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“…However, in the present study, in multivariate analysis, only high grade was significantly associated with a higher rate of clinical response. This result is therefore in agreement with the Nomograms's design proposed online, which does not take into account the histological type of the tumour when deciding on the therapeutic option (Rouzier et al, 2005b). There is room to better define biological predictive factors of response to neoadjuvant chemotherapy to screen patients who would benefit most from this therapeutic option (Sotiriou et al, 2002;Chang et al, 2005;Gianni et al, 2005;Rouzier et al, 2005a;Pierga et al, 2007).…”

Section: Discussionsupporting

confidence: 80%

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

et al. 2008

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The literature reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery. This study aims to compare the outcome of lobular vs ductal carcinomas after neoadjuvant chemotherapy. Between 1989 and 1999, 750 patients with clinical stage II/IIIA ductal (672) or lobular (78) invasive breast carcinomas were treated at the Institut Curie with primary anthracycline-based polychemotherapy followed by either breast conservation (surgery and/or radiotherapy) or mastectomy. Median follow-up was 10 years. Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (47 vs 60%; P ¼ 0.04), but only histological grade remained predictive in multivariate analysis. Breast conservation was high for both ductal and lobular carcinomas (65 and 54%; P ¼ 0.07), due, in part, to the use of radiotherapy, either exclusive or preoperative, for respectively 26 and 40% of patients. The lobular type had no adverse effect, neither on locoregional control nor on overall survival, even in the group of patients treated with breast conservation.

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Section: Discussionsupporting

confidence: 80%

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

et al. 2008

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“…12,13 Statistical predictive models are available for many types of cancer that supply reliable prognostic information for individual patients. [14][15][16] In the recent musculoskeletal oncology literature, nomograms have become a clinically accepted tool with which to predict survival in patients with STS. [17][18][19] The model developed herein and presented as a clinical nomogram was based on multiple logistic regression analysis of clinical factors within our study group.…”

Section: Discussionmentioning

confidence: 99%

Prediction of pathologic fracture risk of the femur after combined modality treatment of soft tissue sarcoma of the thigh

Gortzak

Lockwood

Mahendra

et al. 2010

Cancer

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BACKGROUND:The objective of the current study was to formulate a scoring system to enable decision making for prophylactic stabilization of the femur after surgical resection of a soft tissue sarcoma (STS) of the thigh. METHODS: A logistic regression model was developed using patient variables collected from a prospectively collected database. The study group included 22 patients who developed a radiation-related pathological fracture of the femur after surgery and radiotherapy for an STS of the thigh. The control group of 79 patients received similar treatment but did not sustain a fracture. No patients received chemotherapy. The mean follow-up was 8.6 years. The variables examined were age, gender, tumor size, radiation dose (low [50 grays (Gy)] vs high [!60 Gy]), extent of periosteal stripping (<10 cm, 10-20 cm, and >20 cm), and thigh compartment involvement (posterior, adductor, anterior or other [ie, abductors and groin]). RESULTS: On the basis of an optimal regression model, the ability to predict radiation-associated fracture risk was 91% sensitive and 81% specific. The area under the receiver operating characteristic curve was 0.9, which supports this model as a very accurate predictor of fracture risk. CONCLUSIONS: Radiation-related fractures of the femur after combined surgery and radiotherapy for STS are uncommon, but are difficult to manage and their nonunion rate is extremely high. The results of the current study suggest that it is possible to predict radiation-associated pathological fracture risk using patient and treatment variables with high sensitivity and specificity. This would allow for the identification of high-risk patients and treatment with either close follow-up or prophylactic intramedullary nail stabilization. The presentation of this model as a nomogram will facilitate its clinical use. Cancer 2010;116:1553-9.

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“…Recently, a novel nomogram for predicting response to neoadjuvant chemotherapy was generated by using clinical variables alone 21 ; and, very recently, the nomogram was compared with a genetic predictor (the DLDA-30 predictor). The diagnostic accuracy of the clinical nomogram and genetic predictor reportedly is similar.…”

Section: Discussionmentioning

confidence: 99%

Prediction of pathologic complete response to sequential paclitaxel and 5-fluorouracil/epirubicin/cyclophosphamide therapy using a 70-gene classifier for breast cancers

Naoi

Kishi

Tanei

et al. 2011

Cancer

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BACKGROUND. Sequential administration of paclitaxel plus combined fluorouracil, epirubicin, and cyclophosphamide (P-FEC) is 1 of the most common neoadjuvant chemotherapies for patients with primary breast cancer and produces pathologic complete response (pCR) rates of 20% to 30%. However, a predictor of pCR to this chemotherapy has yet to be developed. The authors developed such a predictor by using a proprietary DNA microarray for gene expression analysis of breast tumor tissues. METHODS. Tumor samples were obtained from 84 patients with breast cancer by core-needle biopsy before the patients received P-FEC, and the gene expression profile was analyzed in those samples to construct a classifier for predicting pCR to P-FEC. In addition, the authors analyzed the gene expression profile of tumor tissues that were obtained at surgery from 105 patients with lymph node-negative and estrogen receptor-positive breast cancer who received adjuvant hormone therapy alone to determine the prognostic significance of the classifier. RESULTS. The 70-gene classifier for predicting pCR to P-FEC was constructed by using the training set (n ¼ 50) and subsequently was validated successfully in the validation set (n ¼ 34), revealing high sensitivity (88%; 95% confidence interval [CI], 47%-100%) and high negative predictive value (93%; 95% CI, 68%-100%). Specificity and positive predictive value were 54% (95% CI, 33%-73%) and 37% (95% CI, 16%-62%), respectively. Among the various parameters (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 status, etc), the 70-gene classifier had the strongest association with pCR (P ¼ .015). In an additional study, genetically assumed complete responders were associated significantly (P ¼ .047) with a poor prognosis. CONCLUSIONS. The 70-gene classifier that was constructed for predicting pCR to P-FEC for breast tumors was successful, with high sensitivity and high negative predictive value. The classifier also appeared to be useful for predicting the prognosis of patients with lymph node-negative and estrogen receptor-positive breast cancer who receive adjuvant hormone therapy alone. Cancer 2011;117:3682-

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Nomograms to Predict Pathologic Complete Response and Metastasis-Free Survival After Preoperative Chemotherapy for Breast Cancer

Abstract: Our nomograms predict pCR accurately and can serve as a basis to integrate future molecular markers into a clinical prediction model.

Cited by 259 publications

References 24 publications

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

Prediction of pathologic fracture risk of the femur after combined modality treatment of soft tissue sarcoma of the thigh

Prediction of pathologic complete response to sequential paclitaxel and 5-fluorouracil/epirubicin/cyclophosphamide therapy using a 70-gene classifier for breast cancers

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