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

Annals of Surgical Oncology volume 23, pages 3501–3509 (2016)Cite this article

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.

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Acknowledgment

This work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672). Dr. Jose Vila is supported by a Grant from Umberto Veronesi Foundation and the Carlos III Health Institute.

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Affiliations

  1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jose Vila MD, Elizabeth A. Mittendorf MD, PhD, Roland L. Bassett PhD, Michael C. Stauder MD, Mariana Chavez-MacGregor MD, MPH, Jennifer F. Litton MD, Lei Huo MD, Henry M. Kuerer MD, PhD, Kelly K. Hunt MD & Abigail S. Caudle MD, MS

  2. The European Institute of Oncology, Milan, Italy

    Jose Vila MD, Gabriel Farante MD, Paolo Veronesi MD, Viviana Galimberti MD & Nicolas Peradze MD

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  1. Jose Vila MD
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  2. Elizabeth A. Mittendorf MD, PhD
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  3. Gabriel Farante MD
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  14. Abigail S. Caudle MD, MS
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Corresponding author

Correspondence to Abigail S. Caudle MD, MS.

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Electronic supplementary material

Below is the link to the electronic supplementary material. Supplemental Fig. 1. Nomogram for predicting axillary pathologic complete response after neoadjuvant chemotherapy using estrogen receptor categorized as positive (>1 % of the cells staining) or negative (0 % of cells staining) without using the number of abnormal nodes on US. The unadjusted AUC is 77.6 %

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Vila, J., Mittendorf, E.A., Farante, G. et al. Nomograms for Predicting Axillary Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Patients with Breast Cancer. Ann Surg Oncol 23, 3501–3509 (2016). https://doi.org/10.1245/s10434-016-5277-1

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  • DOI: https://doi.org/10.1245/s10434-016-5277-1

Keywords

  • Estrogen Receptor
  • Trastuzumab
  • Human Epidermal Growth Factor Receptor
  • Axillary Lymph Node Dissection
  • Validation Cohort