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. 2020 Jun;181(2):339-345.
doi: 10.1007/s10549-020-05623-4. Epub 2020 Apr 6.

External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients

Antonio Piñero-Madrona  1 , Francisco Ripoll-Orts  2 , José Ignacio Sánchez-Méndez  3 , Asunción Chaves-Benito  4 , Maximiliano Rodrigo Gómez-de la Bárcena  5 , Ana Calatrava-Fons  6 , Salomón Menjón-Beltrán  7 , Vicente Peg-Cámara  8
Affiliations

External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients

Antonio Piñero-Madrona et al. Breast Cancer Res Treat. 2020 Jun.

Abstract

Background: A prognostic model based on the results of molecular analysis of sentinel lymph nodes (SLN) is needed to replace the information that staging the entire axilla provided. The aim of the study is to conduct an external validation of a previously developed model for the prediction of 5-year DFS in a group of breast cancer patients that had undergone SLN biopsy assessed by the One Step Nucleic Acid Amplification (OSNA) method.

Methods: We collected retrospective data of 889 patients with breast cancer, who had not received systemic treatment before surgery, and who underwent SLN biopsy and evaluation of all SLN by OSNA. The discrimination ability of the model was assessed by the area under the ROC curve (AUC ROC), and its calibration by comparing 5-years DFS Kaplan-Meier estimates in quartile groups of model predicted probabilities (MPP).

Results: The AUC ROC ranged from 0.78 (at 2 years) to 0.73 (at 5 years) in the training set, and from 0.78 to 0.71, respectively, in the validation set. The MPP allowed to distinguish four groups of patients with heterogeneous DFS (log-rank test p < 0.0001). In the highest risk group, the HR were 6.04 [95% CI 2.70, 13.48] in the training set and 4.79 [2.310, 9.93] in the validation set.

Conclusions: The model for the prediction of 5-year DFS was successfully validated using the most stringent form of validation, in centers different from those involved in the development of the model. The external validation of the model confirms its utility for the prediction of 5-year DFS and the usefulness of the TTL value as a prognostic variable.

Keywords: Breast cancer; Model validation; Prognosis; Sentinel lymph node; Total tumor load.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Distributions of the prognostic index (left) and model predicted probability of DFS at 5 years in the training and validation sets
Fig. 2
Fig. 2
Kaplan–Meier curves of 5-year DFS in the four groups defined by quartiles of the model predicted probabilities (MPP), and log-rank test, in the training and validation sets
Fig. 3
Fig. 3
Nomogram of the validated model to predict probability of DFS at 5 years
See this image and copyright information in PMC

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