Nomogram for Predicting Breast Conservation after Neoadjuvant Chemotherapy
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초록
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 surgeryshould be the first-line treatment in patients with operable breast cancers. Materials and MethodsWe reviewed the data of 513 women, who had stage II or III breast cancer and receivedNCT and surgery from a single institution. The ability of various clinicopathologic factors topredict the achievement of BCS and tumor size reduction to 3 cm was assessed. Nomograms were built and validated in an independent cohort. ResultsBCS was performed in 50.1% of patients, with 42.2% of tumors reduced to 3 cm afterNCT. A multivariate logistic regression analysis showed that smaller initial tumor size, longerdistance between the lesion and the nipple, absence of suspicious calcifications onmammography, 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, andabsence of in situ component were associated with residual tumor size 3 cm (p < 0.05). Two nomograms were developed using these factors. The areas under the receiver operatingcharacteristic curves for nomograms predicting BCS and residual tumor 3 cm were0.800 and 0.777, respectively. The calibration plots showed good agreement between thepredicted and actual probabilities. ConclusionWe have established a model with novel factors that predicts BCS and residual tumor sizeafter NCT. This model can help in making treatment decisions for patients who are candidatesfor NCT.
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 surgeryshould be the first-line treatment in patients with operable breast cancers. Materials and MethodsWe reviewed the data of 513 women, who had stage II or III breast cancer and receivedNCT and surgery from a single institution. The ability of various clinicopathologic factors topredict the achievement of BCS and tumor size reduction to 3 cm was assessed. Nomograms were built and validated in an independent cohort. ResultsBCS was performed in 50.1% of patients, with 42.2% of tumors reduced to 3 cm afterNCT. A multivariate logistic regression analysis showed that smaller initial tumor size, longerdistance between the lesion and the nipple, absence of suspicious calcifications onmammography, 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, andabsence of in situ component were associated with residual tumor size 3 cm (p < 0.05). Two nomograms were developed using these factors. The areas under the receiver operatingcharacteristic curves for nomograms predicting BCS and residual tumor 3 cm were0.800 and 0.777, respectively. The calibration plots showed good agreement between thepredicted and actual probabilities. ConclusionWe have established a model with novel factors that predicts BCS and residual tumor sizeafter NCT. This model can help in making treatment decisions for patients who are candidatesfor NCT.
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