Nomogram for predicting axillary upstaging in clinical node-negative breast cancer patients receiving neoadjuvant chemotherapy
Purpose The prediction of axillary lymph node status after neoadjuvant chemotherapy (NAC) becoming critical because of the advocation of the de-escalation of axillary management. We investigate associated factors of axillary upstaging in clinical node-negative (cN0) breast cancer patients receiving NAC to develop and validate an accurate prediction nomogram. Methods We retrospectively analyzed 1892 breast cancer patients with stage of cT1-3N0 treated by NAC and subsequent surgery between 2010 and 2020 in twenty hospitals across China. Patients randomly divided into a training set and validation set (3:1). Univariate and multivariate logistic regression analysis were performed, after which a nomogram was constructed and validated. Results In total, pathologic node negativity (ypN0) achieved in 1406 (74.3%) patients and another 486 (25.7%) patients upstaged to pathologic node positive (ypN+). Breast pathologic complete response (bpCR) was achieved in 445 (23.5%) patients and non-bpCR in 1447 (76.5%) patients. A nomogram was established by ER, tumor histology, HER2 status, cycle of NAC treatment, and the bpCR, which were confirmed by multivariate logistic analysis as independent predictors of nodal upstaging in the training cohort (n = 1419). The area under the receiver operating characteristic curve (AUC) of the training cohort and validation cohort (n = 473) were 0.73 (95% CI 0.693–0.751) and 0.77 (95% CI 0.723–0.812) respectively. Conclusion We present a nomogram with a nationwide large sample data which can effectively predict axillary upstaging after neoadjuvant chemotherapy to give better advice for individualized axillary lymph node management of breast cancer..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:149 |
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| Enthalten in: |
Journal of cancer research and clinical oncology - 149(2023), 11 vom: 02. Mai, Seite 8769-8778 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Maimaitiaili, Amina [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Axillary upstaging |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s00432-023-04817-9 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC2144704937 |
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| 520 | |a Purpose The prediction of axillary lymph node status after neoadjuvant chemotherapy (NAC) becoming critical because of the advocation of the de-escalation of axillary management. We investigate associated factors of axillary upstaging in clinical node-negative (cN0) breast cancer patients receiving NAC to develop and validate an accurate prediction nomogram. Methods We retrospectively analyzed 1892 breast cancer patients with stage of cT1-3N0 treated by NAC and subsequent surgery between 2010 and 2020 in twenty hospitals across China. Patients randomly divided into a training set and validation set (3:1). Univariate and multivariate logistic regression analysis were performed, after which a nomogram was constructed and validated. Results In total, pathologic node negativity (ypN0) achieved in 1406 (74.3%) patients and another 486 (25.7%) patients upstaged to pathologic node positive (ypN+). Breast pathologic complete response (bpCR) was achieved in 445 (23.5%) patients and non-bpCR in 1447 (76.5%) patients. A nomogram was established by ER, tumor histology, HER2 status, cycle of NAC treatment, and the bpCR, which were confirmed by multivariate logistic analysis as independent predictors of nodal upstaging in the training cohort (n = 1419). The area under the receiver operating characteristic curve (AUC) of the training cohort and validation cohort (n = 473) were 0.73 (95% CI 0.693–0.751) and 0.77 (95% CI 0.723–0.812) respectively. Conclusion We present a nomogram with a nationwide large sample data which can effectively predict axillary upstaging after neoadjuvant chemotherapy to give better advice for individualized axillary lymph node management of breast cancer. | ||
| 650 | 4 | |a Breast cancer | |
| 650 | 4 | |a Clinical lymph node negative | |
| 650 | 4 | |a Neoadjuvant chemotherapy | |
| 650 | 4 | |a Axillary upstaging | |
| 650 | 4 | |a Prediction nomogram | |
| 700 | 1 | |a Chen, Heyan |4 aut | |
| 700 | 1 | |a Xie, Peiling |4 aut | |
| 700 | 1 | |a Liu, Zhenzhen |4 aut | |
| 700 | 1 | |a Ling, Rui |4 aut | |
| 700 | 1 | |a Zhao, Yi |4 aut | |
| 700 | 1 | |a Yang, Hongjian |4 aut | |
| 700 | 1 | |a Liu, Yunjiang |4 aut | |
| 700 | 1 | |a Liu, Ke |4 aut | |
| 700 | 1 | |a Zhang, Jianguo |4 aut | |
| 700 | 1 | |a Mao, Dahua |4 aut | |
| 700 | 1 | |a Yu, Zhigang |4 aut | |
| 700 | 1 | |a Liu, Yinhua |4 aut | |
| 700 | 1 | |a Fu, Peifen |4 aut | |
| 700 | 1 | |a Wang, Jiandong |4 aut | |
| 700 | 1 | |a Jiang, Hongchuan |4 aut | |
| 700 | 1 | |a Zhao, Zuowei |4 aut | |
| 700 | 1 | |a Tian, Xingsong |4 aut | |
| 700 | 1 | |a Cao, Zhongwei |4 aut | |
| 700 | 1 | |a Wu, Kejin |4 aut | |
| 700 | 1 | |a Song, Ailin |4 aut | |
| 700 | 1 | |a Jin, Feng |4 aut | |
| 700 | 1 | |a He, Jianjun |4 aut | |
| 700 | 1 | |a Fan, Zhimin |0 (orcid)0000-0001-5236-7814 |4 aut | |
| 700 | 1 | |a Zhang, Huimin |0 (orcid)0000-0003-2636-7858 |4 aut | |
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