Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy
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The aim of this study was to combine clinical pathologic variables that are associated with pathologic completer response (pCR) and relapse-free survival (RFS) after neoadjuvant chemotherapy into prediction nomograms.
A total of 370 stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. We developed the nomograms using logistic regression model for pCR and Cox proportional hazard regression model for RFS.
The nomogram for pCR based on initial tumor size, estrogen receptor (ER), human epidermal growth factor receptor 2, and Ki67 had good discrimination performance (AUROC = 0.830). Multivariate Cox model identified age less than 35, initial clinical stage, pathologic stage, ER, Ki67 as prognostic factors, and the nomogram for RFS was developed based on these covariates. The concordance index for the second nomogram was 0.781, and calibration was also good.
We developed nomograms based on clinical and pathologic characteristics to predict the probability of pCR and RFS for patients receiving neoadjuvant docetaxel/doxorubicin chemotherapy.
KeywordsNomogram Breast cancer Neoadjuvant chemotherapy Prediction
- Colleoni M, Bagnardi V, Rotmensz N, Dellapasqua S, Viale G, Pruneri G, Veronesi P, Torrisi R, Luini A, Intra M, Galimberti V, Montagna E, Goldhirsch A (2009) A risk score to predict disease-free survival in patients not achieving a pathological complete remission after preoperative chemotherapy for breast cancer. Ann Oncol 20:1178–1184PubMedCrossRefGoogle Scholar
- Gralow JR, Burstein HJ, Wood W, Hortobagyi GN, Gianni L, von Minckwitz G, Buzdar AU, Smith IE, Symmans WF, Singh B, Winer EP (2008) Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol 26:814–819PubMedCrossRefGoogle Scholar
- Hosmer DW, Lemeshow S (1999) Applied survival analysis: regression modeling of time to event data. Wiley, New YorkGoogle Scholar
- Jeruss JS, Mittendorf EA, Tucker SL, Gonzalez-Angulo AM, Buchholz TA, Sahin AA, Cormier JN, Buzdar AU, Hortobagyi GN, Hunt KK (2008a) Combined use of clinical and pathologic staging variables to define outcomes for breast cancer patients treated with neoadjuvant therapy. J Clin Oncol 26:246–252PubMedCrossRefGoogle Scholar
- Jones RL, Salter J, A’Hern R, Nerurkar A, Parton M, Reis-Filho JS, Smith IE, Dowsett M (2010) Relationship between oestrogen receptor status and proliferation in predicting response and long-term outcome to neoadjuvant chemotherapy for breast cancer. Br Cancer Res Treat 119:315–323CrossRefGoogle Scholar
- Keam B, Im SA, Kim HJ, Oh DY, Kim JH, Lee SH, Chie EK, Han W, Kim DW, Moon WK, Kim TY, Park IA, Noh DY, Heo DS, Ha SW, Bang YJ (2007) Prognostic impact of clinicopathologic parameters in stage II/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer. BMC Cancer 7:203PubMedCrossRefGoogle Scholar
- Keam B, Im SA, Kim HJ, Oh DY, Kim JH, Lee SH, Chie EK, Han W, Kim DW, Cho N, Moon WK, Kim TY, Park IA, Noh DY, Heo DS, Ha SW, Bang YJ (2009) Clinical significance of axillary nodal ratio in stage II/III breast cancer treated with neoadjuvant chemotherapy. Br Cancer Res Treat 116:153–160CrossRefGoogle Scholar
- Kohrt HE, Olshen RA, Bermas HR, Goodson WH, Wood DJ, Henry S, Rouse RV, Bailey L, Philben VJ, Dirbas FM, Dunn JJ, Johnson DL, Wapnir IL, Carlson RW, Stockdale FE, Hansen NM, Jeffrey SS (2008) New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer 8:66PubMedCrossRefGoogle Scholar
- Lee KH, Im SA, Oh DY, Lee SH, Chie EK, Han W, Kim DW, Kim TY, Park IA, Noh DY, Heo DS, Ha SW, Bang YJ (2007) Prognostic significance of bcl-2 expression in stage III breast cancer patients who had received doxorubicin and cyclophosphamide followed by paclitaxel as adjuvant chemotherapy. BMC Cancer 7:63PubMedCrossRefGoogle Scholar
- Mazouni C, Peintinger F, Wan-Kau S, Andre F, Gonzalez-Angulo AM, Symmans WF, Meric-Bernstam F, Valero V, Hortobagyi GN, Pusztai L (2007) Residual ductal carcinoma in situ in patients with complete eradication of invasive breast cancer after neoadjuvant chemotherapy does not adversely affect patient outcome. J Clin Oncol 25:2650–2655PubMedCrossRefGoogle Scholar
- Nam BH (2000) Discrimination and calibration in survival analysis, Doctoral dissertation. Boston University, Boston, MAGoogle Scholar
- Rouzier R, Pusztai L, Delaloge S, Gonzalez-Angulo AM, Andre F, Hess KR, Buzdar AU, Garbay JR, Spielmann M, Mathieu MC, Symmans WF, Wagner P, Atallah D, Valero V, Berry DA, Hortobagyi GN (2005) Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol 23:8331–8339PubMedCrossRefGoogle Scholar
- Rouzier R, Pusztai L, Garbay JR, Delaloge S, Hunt KK, Hortobagyi GN, Berry D, Kuerer HM (2006) Development and validation of nomograms for predicting residual tumor size and the probability of successful conservative surgery with neoadjuvant chemotherapy for breast cancer. Cancer 107:1459–1466PubMedCrossRefGoogle Scholar
- Symmans WF, Peintinger F, Hatzis C, Rajan R, Kuerer H, Valero V, Assad L, Poniecka A, Hennessy B, Green M, Buzdar AU, Singletary SE, Hortobagyi GN, Pusztai L (2007) Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol 25:4414–4422PubMedCrossRefGoogle Scholar
- Van Zee KJ, Manasseh DM, Bevilacqua JL, Boolbol SK, Fey JV, Tan LK, Borgen PI, Cody HS III, Kattan MW (2003) A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10:1140–1151PubMedCrossRefGoogle Scholar