Robert-Jan Schipper1, Martine Moossdorff2, Patty J Nelemans3, Grard A P Nieuwenhuijzen4, Bart de Vries5, Luc J A Strobbe6, Rudi M H Roumen7, Franchette van den Berkmortel8, Vivianne C G Tjan-Heijnen9, Regina G H Beets-Tan10, Marc B I Lobbes10, Marjolein L Smidt2. 1. Department of Radiology, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands. Electronic address: info@rjschipper.nl. 2. Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands. 3. Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands. 4. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 5. Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands. 6. Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. 7. Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. 8. Department of Internal Medicine, Atrium Medical Center (Parkstad), Heerlen, The Netherlands. 9. Division of Medical Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands. 10. Department of Radiology, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
Abstract
BACKGROUND: Between 20% and 42% of patients with clinically node-positive breast cancer achieve a pathologic complete response (pCR) of axillary lymph nodes after neoadjuvant chemotherapy or immunotherapy, or both, (chemo[immuno]therapy). Hypothetically, axillary lymph node dissection (ALND) may be safely omitted in these patients. This study aimed to develop a model for predicting axillary pCR in these patients. PATIENTS AND METHODS: We retrospectively identified patients with clinically node-positive breast cancer who were treated with neoadjuvant chemo(immuno)therapy and ALND between 2005 and 2012 in 5 hospitals. Patient and tumor characteristics, neoadjuvant chemo(immuno)therapy regimens, and pathology reports were extracted. Binary logistic regression analysis was used to predict axillary pCR with the following variables: age, tumor stage and type, hormone receptor and human epidermal growth factor receptor 2 (HER2) status, and administration of taxane and trastuzumab. The model was internally validated by bootstrap resampling. The overall performance of the model was assessed by the Brier score and the discriminative performance by receiver operating characteristic (ROC) curve analysis. RESULTS: A model was developed based on 291 patients and was internally validated with a scaled Brier score of 0.14. The area under the ROC curve of this model was 0.77 (95% confidence interval [CI], 0.71-0.82). At a cutoff value of predicted probability ≥ 0.50, the model demonstrated specificity of 88%, sensitivity of 43%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 75%. CONCLUSION: This prediction model shows reasonable accuracy for predicting axillary pCR. However, omitting axillary treatment based solely on the nomogram score is not justified. Further research is warranted to noninvasively identify patients with axillary pCR.
BACKGROUND: Between 20% and 42% of patients with clinically node-positive breast cancer achieve a pathologic complete response (pCR) of axillary lymph nodes after neoadjuvant chemotherapy or immunotherapy, or both, (chemo[immuno]therapy). Hypothetically, axillary lymph node dissection (ALND) may be safely omitted in these patients. This study aimed to develop a model for predicting axillary pCR in these patients. PATIENTS AND METHODS: We retrospectively identified patients with clinically node-positive breast cancer who were treated with neoadjuvant chemo(immuno)therapy and ALND between 2005 and 2012 in 5 hospitals. Patient and tumor characteristics, neoadjuvant chemo(immuno)therapy regimens, and pathology reports were extracted. Binary logistic regression analysis was used to predict axillary pCR with the following variables: age, tumor stage and type, hormone receptor and humanepidermal growth factor receptor 2 (HER2) status, and administration of taxane and trastuzumab. The model was internally validated by bootstrap resampling. The overall performance of the model was assessed by the Brier score and the discriminative performance by receiver operating characteristic (ROC) curve analysis. RESULTS: A model was developed based on 291 patients and was internally validated with a scaled Brier score of 0.14. The area under the ROC curve of this model was 0.77 (95% confidence interval [CI], 0.71-0.82). At a cutoff value of predicted probability ≥ 0.50, the model demonstrated specificity of 88%, sensitivity of 43%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 75%. CONCLUSION: This prediction model shows reasonable accuracy for predicting axillary pCR. However, omitting axillary treatment based solely on the nomogram score is not justified. Further research is warranted to noninvasively identify patients with axillary pCR.
Authors: I Osorio-Silla; A Gómez Valdazo; J I Sánchez Méndez; E York; M Díaz-Almirón; J Gómez Ramírez; S Rivas Fidalgo; J M Oliver; C M Álvarez; D Hardisson; M Díaz Miguel; F Lobo; J Díaz Domínguez Journal: Ann R Coll Surg Engl Date: 2018-11-13 Impact factor: 1.891
Authors: Thorsten Kühn; Jean-Marc Classe; Oreste David Gentilini; Corrado Tinterri; Florentia Peintinger; Jana de Boniface Journal: Breast Care (Basel) Date: 2018-09-26 Impact factor: 2.860
Authors: Orli Friedman-Eldar; Tolga Ozmen; Salah James El Haddi; Neha Goel; Youley Tjendra; Susan B Kesmodel; Mecker G Moller; Dido Franceschi; Christina Layton; Eli Avisar Journal: Ann Surg Oncol Date: 2022-03-18 Impact factor: 5.344