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Qian B, Yang J, Zhou J, Hu L, Zhang S, Ren M, Qu X. Individualized model for predicting pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: A multicenter study. Front Endocrinol (Lausanne) 2022; 13:955250. [PMID: 36060977 PMCID: PMC9428399 DOI: 10.3389/fendo.2022.955250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pathological complete response (pCR) is considered a surrogate for favorable survival in breast cancer (BC) patients treated with neoadjuvant chemotherapy (NACT), which is the goal of NACT. This study aimed to develop and validate a nomogram for predicting the pCR probability of BC patients after NACT based on the clinicopathological features. METHODS A retrospective analysis of 527 BC patients treated with NACT between January 2018 and December 2021 from two institutions was conducted. Univariate and multivariate logistic regression analyses were performed to select the most useful predictors from the training cohort (n = 225), and then a nomogram model was developed. The performance of the nomogram was evaluated with respect to its discrimination, calibration, and clinical usefulness. Internal validation and external validation were performed in an independent validation cohort of 96 and 205 consecutive BC patients, respectively. RESULTS Among the 18 clinicopathological features, five variables were selected to develop the prediction model, including age, American Joint Committee on Cancer (AJCC) T stage, Ki67 index before NACT, human epidermal growth factor receptor 2 (HER2), and hormone receptor (HR) status. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.825 (95% CI, 0.772 to 0.878) in the training cohort, and 0.755 (95% CI, 0.658 to 0.851) and 0.79 (95% CI, 0.724 to 0.856) in the internal and external validation cohorts, respectively. The calibration curve presented good agreement between prediction by nomogram and actual observation, and decision curve analysis (DCA) indicated that the nomogram had good net benefits in clinical scenarios. CONCLUSION This study constructed a validated nomogram based on age, AJCC T stage, Ki67 index before NACT, HER2, and HR status, which could be non-invasively applied to personalize the prediction of pCR in BC patients treated with NACT.
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Affiliation(s)
- Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yang
- Department of Breast Surgery, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Zhou
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shoupeng Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xincai Qu, ; Min Ren, ; Shoupeng Zhang,
| | - Min Ren
- Department of Breast Surgery, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Xincai Qu, ; Min Ren, ; Shoupeng Zhang,
| | - Xincai Qu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xincai Qu, ; Min Ren, ; Shoupeng Zhang,
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Del Prete S, Caraglia M, Luce A, Montella L, Galizia G, Sperlongano P, Cennamo G, Lieto E, Capasso E, Fiorentino O, Aliberti M, Auricchio A, Iodice P, Addeo R. Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in breast cancer: A single center experience. Oncol Lett 2019; 18:3873-3879. [PMID: 31516598 DOI: 10.3892/ol.2019.10729] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) of breast cancer (BC) improves outcomes, especially in patients with locally advanced and inflammatory cancer. Further insight into clinic-pathological factors influencing outcomes is essential to define the optimal therapeutic strategy for each category of patients and to predict the response to the treatment. In total, 117 patients with BC were treated with NAC with or without trastuzumab between 2010 and 2015. The histologic response to NAC was defined as a pathological complete response (pCR) when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Relapse-free survival (RFS) was estimated using the Kaplan-Meier method and compared using log rank analysis. P-value <0.05 was considered statistically significant. The median age of the 117 patients enrolled in the present study was 52 years (age range, 35-85 years). The overall response rate (complete and partial responses) assessed by radiological and pathological evaluation were 76 and 72%, respectively. pCR was achieved in 35 out of 117 patients (~30%). In total, 6 patients (5%) developed progressive disease during chemotherapy. The RFS was 85 months (SE=3; 95% CI 79-91). The median was not reached and the mean follow-up time was 55 months (median 52 months; range 11-100 months). In this time, 20 patients (17%) experienced tumor recurrence. From the univariate analysis, the pathological response was significantly associated with receptor-based subtype, menopausal status and T-stage. From the multivariate analysis by using linear multiple regression and including receptor- menopausal status and T-stage, the model was not significant (P=0.062). However, by using the multiple logistic regression, and including age, pCR was significantly associated with ER+ HER2neg (P=0.006), T2 (P=0.043) and T3 (P=0.018). T-stage, menopausal status and receptor status are significantly associated with the pathological response in patients with inoperable BC treated with NAC.
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Affiliation(s)
- Salvatore Del Prete
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Amalia Luce
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Liliana Montella
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
| | - Gennaro Galizia
- Division of Gastrointestinal Tract Surgical Oncology, Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Pasquale Sperlongano
- Division of Gastrointestinal Tract Surgical Oncology, Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Gregorio Cennamo
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
| | - Eva Lieto
- Division of Gastrointestinal Tract Surgical Oncology, Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Elena Capasso
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
| | - Olga Fiorentino
- Pathologist Department, Medicina Futura Group, I-80011 Naples, Italy
| | - Maria Aliberti
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
| | - Annamaria Auricchio
- Division of Gastrointestinal Tract Surgical Oncology, Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Patrizia Iodice
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
| | - Raffaele Addeo
- Division of Medical Oncology, 'San Giovanni Di Dio Hospital', ASL NA2NORD, I-80027 Naples, Italy
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