Ann Surg Treat Res.  2019 Apr;96(4):169-176. 10.4174/astr.2019.96.4.169.

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

• Choi HJ
• Ryu JM
• Kim I
• Nam SJ
• Kim SW
• Yu J
• Lee JE
• Lee SK

• KMID: 2442211
• DOI: http://doi.org/10.4174/astr.2019.96.4.169

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.

Keyword

Complete response; Neoadjuvant treatment; Nomograms

MeSH Terms

Area Under Curve
Breast Neoplasms*
Breast*
Calibration
Discrimination (Psychology)
Drug Therapy*
Humans
Logistic Models
Lymph Nodes
Neoadjuvant Therapy
Neoplasm Metastasis
Nomograms*
Polymerase Chain Reaction
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

• 

  Fig. 1 Nomogram for the prediction of the probability of the pathologic complete response. PR, progesterone receptor; HER2, human epidermal growth factor receptor 2.

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  Fig. 2 The receiver-operating characteristics (ROC) curve and the calibration plot of the nomogram in the training set. (A) ROC curve with area under the curve = 0.868 (95% confidence interval, 0.845–0.891). (B) Calibration plot of the nomogram.

• 

  Fig. 3 The receiver-operating characteristics (ROC) curve of the nomogram in the cross-validation set. (A) ROC curve with area under the curve = 0.853 (95% confidence interval, 0.837–0.869). (B) Calibration plot of the nomogram.

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