Nomograms for Predicting Axillary Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Patients with Breast Cancer View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-10

AUTHORS

Jose Vila, Elizabeth A. Mittendorf, Gabriel Farante, Roland L. Bassett, Paolo Veronesi, Viviana Galimberti, Nicolas Peradze, Michael C. Stauder, Mariana Chavez-MacGregor, Jennifer F. Litton, Lei Huo, Henry M. Kuerer, Kelly K. Hunt, Abigail S. Caudle

ABSTRACT

BACKGROUND: Many patients with clinically node-positive breast cancer receive neoadjuvant chemotherapy (NAC). Recent trials suggest the potential for limiting axillary surgery in patients who convert to pathologically node-negative disease. The authors developed a nomogram to predict axillary response to NAC in patients with cN1 disease that can assist clinicians in treatment planning. METHODS: Patients with cT1-4N1M0 breast cancer who received NAC and underwent axillary lymph node dissection from 2001 through 2013 were identified (n = 584). Uni- and multivariate logistic regression analyses were performed to determine factors predictive of nodal conversion. A nomogram to predict the likelihood of nodal pathologic complete response (pCR) was constructed based on clinicopathologic variables and validated using an external dataset. RESULTS: Axillary pCR was achieved for 217 patients (37 %). Patients presenting with high nuclear grade [grade 3 vs. 1, odds ratio (OR) 13.4], human epidermal growth factor receptor 2-positive (OR 4.7), estrogen receptor (ER)-negative (OR 3.5), or progesterone receptor-negative (OR 4.3) tumors were more likely to achieve nodal pCR. These factors, together with clinically relevant factors including presence of multifocal/centric disease, clinical T stage, and extent of nodal disease seen on regional nodal ultrasound at diagnosis were used to create nomograms predicting nodal conversion. The discrimination of the nomogram using ER+ status (>1 % staining) versus ER- status [area under the curve (AUC) 78 %] was improved slightly using the percentage of ER staining (AUC 78.7 %). Both nomograms were validated using an external cohort. CONCLUSION: Nomograms incorporating routine clinicopathologic parameters can predict axillary pCR in node-positive patients receiving NAC and may help to inform treatment decisions. More... »

PAGES

3501-3509

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-016-5277-1

DOI

http://dx.doi.org/10.1245/s10434-016-5277-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1012580388

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27216742


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