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Multicenter Study
. 2021 Dec:60:131-137.
doi: 10.1016/j.breast.2021.09.013. Epub 2021 Oct 2.

Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer: A multicentre study on 1,950 patients

Fabio Corsi  1 , Sara Albasini  2 , Luca Sorrentino  3 , Giulia Armatura  4 , Claudia Carolla  5 , Corrado Chiappa  6 , Francesca Combi  7 , Annalisa Curcio  8 , Angelica Della Valle  9 , Guglielmo Ferrari  10 , Maria Luisa Gasparri  11 , Oreste Gentilini  12 , Matteo Ghilli  13 , Chiara Listorti  5 , Stefano Mancini  14 , Peter Marinello  4 , Francesco Meani  15 , Simone Mele  10 , Anna Pertusati  16 , Manuela Roncella  13 , Francesca Rovera  6 , Adele Sgarella  17 , Giovanni Tazzioli  7 , Daniela Tognali  8 , Secondo Folli  5
Affiliations
Multicenter Study

Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer: A multicentre study on 1,950 patients

Fabio Corsi et al. Breast. 2021 Dec.

Abstract

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.

Keywords: Axillary dissection; Axillary surgery; Breast cancer; Neoadjuvant chemotherapy; Sentinel node biopsy.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1
Fig. 1
Nomogram to predict the individual probability of nodal pCR after NAC. ∗Assessed on core biopsy before neoadjuvant chemotherapy.
Fig. 2
Fig. 2
Performance of the proposed nomogram in predicting the individual probability of nodal pCR after NAC evaluated by ROC curve.
See this image and copyright information in PMC

References

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