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Development and validation of a nomogram based on pretreatment dynamic contrast-enhanced MRI for the prediction of pathologic response after neoadjuvant chemotherapy for triple-negative breast cancer

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Abstract

Objectives

To develop a nomogram based on pretreatment dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with triple-negative breast cancer (TNBC).

Methods

A total of 108 female patients with TNBC treated with neoadjuvant chemotherapy followed by surgery between January 2017 and October 2020 were enrolled. The patients were randomly divided into the primary cohort (n = 87) and validation cohort (n = 21) at a ratio of 4:1. The pretreatment DCE-MRI and clinicopathological features were reviewed and recorded. Univariate analysis and multivariate logistic regression analyses were used to determine the independent predictors of pCR in the primary cohort. A nomogram was developed based on the predictors, and the predictive performance of the nomogram was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). The validation cohort was used to test the predictive model.

Results

Tumor volume measured on DCE-MRI, time to peak (TTP), and androgen receptor (AR) status were identified as independent predictors of pCR. The AUCs of the nomogram were 0.84 (95% CI: 0.75–0.93) and 0.79 (95% CI: 0.59–0.99) in the primary cohort and validation cohort, respectively.

Conclusions

Pretreatment DCE-MRI could predict pCR after NAC in patients with TNBC. The nomogram can be used to predict the probability of pCR and may help individualize treatment.

Key Points

• Pretreatment DCE-MRI findings can predict pathologic complete response (pCR) after neoadjuvant chemotherapy in patients with triple-negative breast cancer.

• A nomogram based on the independent predictors of tumor volume measured on DCE-MRI, time to peak, and androgen receptor status could help personalized cancer treatment in TNBC patients.

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Abbreviations

ADC :

Apparent diffusion coefficient

AJCC :

American Joint Committee on Cancer

AR :

Androgen receptor

AUC :

Area under the curve

BI-RADS® :

Breast Imaging Reporting and Data System

BMI :

Body mass index

CEA :

Carcinoembryonic antigen

CI :

Confidence interval

DCE-MRI :

Dynamic contrast-enhanced magnetic resonance imaging

EER :

Early enhancement ratio

ER :

Estrogen receptor

HER2 :

Human epidermal growth factor receptor 2

LER :

Late enhancement ratio

LVI :

Lymphovascular invasion

NAC :

Neoadjuvant chemotherapy

pCR :

Pathologic complete response

PER :

Peak enhancement ratio

PR :

Progesterone receptor

ROC :

Receiver operating characteristic

TNBC :

Triple-negative breast cancer

TTP :

Time to peak

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Funding

This study has received funding by research projects for pharmacy, laboratory science, and radiology, Tianjin Medical University Cancer Institute and Hospital (Y1903), Tianjin, China.

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Authors and Affiliations

  1. Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China

    Yanbo Li, Rui Zhao, Yu Ji, Junnan Li, Ying Zhang & Hong Lu

  2. Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Tianjin, People’s Republic of China

    Yanbo Li, Yongzi Chen, Rui Zhao, Yu Ji, Junnan Li, Ying Zhang & Hong Lu

  3. Laboratory of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China

    Yongzi Chen

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  1. Yanbo Li
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  7. Hong Lu
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Correspondence to Hong Lu.

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Li, Y., Chen, Y., Zhao, R. et al. Development and validation of a nomogram based on pretreatment dynamic contrast-enhanced MRI for the prediction of pathologic response after neoadjuvant chemotherapy for triple-negative breast cancer. Eur Radiol 32, 1676–1687 (2022). https://doi.org/10.1007/s00330-021-08291-0

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