Cancer Res Treat.  2015 Apr;47(2):197-207. 10.4143/crt.2013.247.

Nomogram for Predicting Breast Conservation after Neoadjuvant Chemotherapy

• Kim MK
• Han W
• Moon HG
• Ahn SK
• Kim J
• Lee JW
• Kim JY
• Kim T
• Lee KH
• Kim TY
• Han SW
• Im SA
• Kim TY
• Park IA
• Noh DY

• KMID: 2132798
• DOI: http://doi.org/10.4143/crt.2013.247

Abstract

PURPOSE
The ability to accurately predict the likelihood of achieving breast conservation surgery (BCS) after neoadjuvant chemotherapy (NCT) is important in deciding whether NCT or surgery should be the first-line treatment in patients with operable breast cancers.
MATERIALS AND METHODS
We reviewed the data of 513 women, who had stage II or III breast cancer and received NCT and surgery from a single institution. The ability of various clinicopathologic factors to predict the achievement of BCS and tumor size reduction to < or = 3 cm was assessed. Nomograms were built and validated in an independent cohort.
RESULTS
BCS was performed in 50.1% of patients, with 42.2% of tumors reduced to < or = 3 cm after NCT. A multivariate logistic regression analysis showed that smaller initial tumor size, longer distance between the lesion and the nipple, absence of suspicious calcifications on mammography, and a single tumor were associated with BCS rather than mastectomy (p < 0.05). Negative estrogen receptor, smaller initial tumor size, higher Ki-67 level, and absence of in situ component were associated with residual tumor size < or = 3 cm (p < 0.05). Two nomograms were developed using these factors. The areas under the receiver operating characteristic curves for nomograms predicting BCS and residual tumor < or = 3 cm were 0.800 and 0.777, respectively. The calibration plots showed good agreement between the predicted and actual probabilities.
CONCLUSION
We have established a model with novel factors that predicts BCS and residual tumor size after NCT. This model can help in making treatment decisions for patients who are candidates for NCT.

Keyword

Segmental mastectomy; Neoadjuvant therapy; Nomograms; Breast neoplasms

MeSH Terms

Breast Neoplasms
Breast*
Calibration
Cohort Studies
Drug Therapy*
Estrogens
Female
Humans
Logistic Models
Mammography
Mastectomy
Mastectomy, Segmental
Neoadjuvant Therapy
Neoplasm, Residual
Nipples
Nomograms*
ROC Curve
Estrogens

Figure

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  Fig. 1. Nomogram predicting eligibility for breast conservation surgery.

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  Fig. 2. Nomogram predicting the probability of residual tumor size ≤ 3 cm. ER, estrogen receptor; DCIS, ductal carcinoma in situ; NCT, neoadjuvant chemotherapy.

Reference

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