TY - JOUR
T1 - Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer
T2 - A multicentre study on 1,950 patients
AU - Corsi, Fabio
AU - Albasini, Sara
AU - Sorrentino, Luca
AU - Armatura, Giulia
AU - Carolla, Claudia
AU - Chiappa, Corrado
AU - Combi, Francesca
AU - Curcio, Annalisa
AU - Della Valle, Angelica
AU - Ferrari, Guglielmo
AU - Gasparri, Maria Luisa
AU - Gentilini, Oreste
AU - Ghilli, Matteo
AU - Listorti, Chiara
AU - Mancini, Stefano
AU - Marinello, Peter
AU - Meani, Francesco
AU - Mele, Simone
AU - Pertusati, Anna
AU - Roncella, Manuela
AU - Rovera, Francesca
AU - Sgarella, Adele
AU - Tazzioli, Giovanni
AU - Tognali, Daniela
AU - Folli, Secondo
N1 - Funding Information:
External validation is essential to support generalizability of the prediction nomogram for patients other than those in the development cohort [26]. The same model developed in Table 3 was applied on the external validation cohort: the accuracy of the nomogram was confirmed with an AUC of 0.77 (95%CI [0.73?0.82]). Calibration on external cohort was performed by graphical method (Supplementary Fig S3).
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Background: Type of axillary surgery in breast cancer (BC) patients who convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized. Patients and methods: 1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR). Results: Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89, p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2 (OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75–0.80). After external validation the accuracy of the nomogram was confirmed. Conclusion: The accuracy makes this freely-available, nomogram-based online tool useful to predict nodal pCR after NAC, translating the concept of tailored axillary surgery also in this setting of patients.
AB - Background: Type of axillary surgery in breast cancer (BC) patients who convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized. Patients and methods: 1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR). Results: Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89, p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2 (OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75–0.80). After external validation the accuracy of the nomogram was confirmed. Conclusion: The accuracy makes this freely-available, nomogram-based online tool useful to predict nodal pCR after NAC, translating the concept of tailored axillary surgery also in this setting of patients.
KW - Axillary dissection
KW - Axillary surgery
KW - Breast cancer
KW - Neoadjuvant chemotherapy
KW - Sentinel node biopsy
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U2 - 10.1016/j.breast.2021.09.013
DO - 10.1016/j.breast.2021.09.013
M3 - Article
AN - SCOPUS:85116462438
VL - 60
SP - 131
EP - 137
JO - Breast
JF - Breast
SN - 0960-9776
ER -