1
|
Ouldamer L, Bendifallah S, Pilloy J, Arbion F, Body G, Brisson C, Lavoué V, Lévêque J, Daraï E. Risk scoring system for predicting breast conservation after neoadjuvant chemotherapy. Breast J 2019; 25:696-701. [PMID: 31066151 DOI: 10.1111/tbj.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
We developed a risk scoring system (RSS) for predicting breast conservative surgery (BCS) in women receiving neoadjuvant chemotherapy(NAC) for breast cancer. BCS rate in the training set was 32.6%, associated with five variables: age < 50years, primary radiological tumor diameter < 60mm, absence of multifocality, absence of breast inflammation and hormone receptor status. These variables were assigned scores ranging from 0 to 9. The discrimination of the RSS was 0.78(95%CI 0.69-0.86) in the training set. The area under the curve of the receiver operating characteristics for predicting BCS after internal and external validation was 0.77(95%CI 0.68-0.85) and 0.75(95%CI 0.66-0.84), respectively.
Collapse
Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069, Université François-Rabelais, Tours, France
| | - Sofiane Bendifallah
- Department of Gynaecology, Hôpital Tenon, Paris, France.,INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Joseph Pilloy
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Flavie Arbion
- Department of Pathology, Centre Hospitalier Universitaire de Tours, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069, Université François-Rabelais, Tours, France
| | - Caroline Brisson
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069, Université François-Rabelais, Tours, France
| | - Vincent Lavoué
- Department of Gynaecology, CHU Anne de Bretagne, Rennes, France
| | - Jean Lévêque
- Department of Gynaecology, CHU Anne de Bretagne, Rennes, France
| | - Emile Daraï
- Department of Gynaecology, Hôpital Tenon, Paris, France
| |
Collapse
|
2
|
Xiong Z, Deng G, Huang X, Li X, Xie X, Wang J, Shuang Z, Wang X. Score for the Survival Probability in Metastasis Breast Cancer: A Nomogram-Based Risk Assessment Model. Cancer Res Treat 2018; 50:1260-1269. [PMID: 29334609 PMCID: PMC6192925 DOI: 10.4143/crt.2017.443] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Survival of metastatic breast cancer (MBC) patient remains unknown and varies greatly from person to person. Thus, we aimed to construct a nomogram to quantify the survival probability of patients with MBC. Materials and Methods We had included 793 MBC patients and calculated trends of case fatality rate by Kaplan-Meier method and joinpoint regression. Six hundred thirty-four patients with MBC between January 2004 and July 2011 and 159 patients with MBC between August 2011 and July 2013 were assigned to training cohort and internal validation cohort, respectively. We constructed the nomogram based on the results of univariable and multivariable Cox regression analyses in the training cohort and validated the nomogram in the validation cohort. Concordance index and calibration curves were used to assess the effectiveness of nomogram. RESULTS Case fatality rate of MBC was increasing (annual percentage change [APC], 21.6; 95% confidence interval [CI], 1.0 to 46.3; p < 0.05) in the first 18 months and then decreased (APC, ‒4.5; 95% CI, ‒8.2 to ‒0.7; p < 0.05). Metastasis-free interval, age, metastasis location, and hormone receptor status were independent prognostic factors and were included in the nomogram, which had a concordance index of 0.69 in the training cohort and 0.67 in the validation cohort. Calibration curves indicated good consistency between the two cohorts at 1 and 3 years. CONCLUSION In conclusion, the fatality risk of MBC was increasing and reached the summit between 13th and 18th month afterthe detection of MBC. We have developed and validated a nomogram to predict the 1- and 3-year survival probability in MBC.
Collapse
Affiliation(s)
- Zhenchong Xiong
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guangzheng Deng
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinjian Huang
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xing Li
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinhua Xie
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jin Wang
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zeyu Shuang
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xi Wang
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
3
|
Pilloy J, Fleurier C, Chas M, Bédouet L, Jourdan ML, Arbion F, Body G, Ouldamer L. [Predictive factors of conservative breast surgery after neoadjuvant chemotherapy for breast cancer]. ACTA ACUST UNITED AC 2017; 45:466-471. [PMID: 28869182 DOI: 10.1016/j.gofs.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of our study was to evaluate the existence of predictive factors of conservative breast surgery after neoadjuvant chemotherapy (NAC) for breast cancer. METHODS We included all women with invasive breast cancer who received NAC and underwent breast surgery between January 2007 and December 2013 in our institution. Univariable and multivariable analyses were performed to determine the association between clinical and histological factors and conservative breast surgery. RESULTS During the study period, 229 women were included of whom 73 had breast conservative surgery (32%). At univariable analysis, significant predictive factors were age (OR 0.97 [CI 95% 0.95-0.99], P=0.02), radiological size (OR 0.97 [CI 95% 0.96-0.99], P<0.001), multifocality (OR 0.53 [CI 95% 0.27-1.05], P=0.06), breast inflammation (OR 0.15 [CI 95% 0.07-0.32], P<0.001) and the type of hormone receptors (P=0.12). In multivariable analysis, all these factors but age were significant factors and thus considered as independent predictive factors. CONCLUSION This work permitted to identify independent predictive factors of breast conservative surgery after NAC for breast cancer that will be included in a risk scoring system that we aim to evaluate prospectively.
Collapse
Affiliation(s)
- J Pilloy
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - C Fleurier
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M Chas
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - L Bédouet
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M L Jourdan
- Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - F Arbion
- Département de pathologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Département de pathologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France.
| |
Collapse
|
4
|
Genre L, Roché H, Varela L, Kanoun D, Ouali M, Filleron T, Dalenc F. External validation of a published nomogram for prediction of brain metastasis in patients with extra-cerebral metastatic breast cancer and risk regression analysis. Eur J Cancer 2016; 72:200-209. [PMID: 28042991 DOI: 10.1016/j.ejca.2016.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/04/2016] [Accepted: 10/21/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Survival of patients with metastatic breast cancer (MBC) suffering from brain metastasis (BM) is limited and this event is usually fatal. In 2010, the Graesslin's nomogram was published in order to predict subsequent BM in patients with breast cancer (BC) with extra-cerebral metastatic disease. This model aims to select a patient population at high risk for BM and thus will facilitate the design of prevention strategies and/or the impact of early treatment of BM in prospective clinical studies. PATIENTS AND METHODS Nomogram external validation was retrospectively applied to patients with BC and later BM between January 2005 and December 2012, treated in our institution. Moreover, risk factors of BM appearance were studied by Fine and Gray's competing risk analysis. RESULTS Among 492 patients with MBC, 116 developed subsequent BM. Seventy of them were included for the nomogram validation. The discrimination is good (area under curve = 0.695 [95% confidence interval, 0.61-0.77]). Risk factors of BM appearance are: human epidermal growth factor receptor 2 (HER2) overexpression/amplification, triple-negative BC and number of extra-cerebral metastatic sites (>1). With a competing risk model, we highlight the nomogram interest for HER2+ tumour subgroup exclusively. CONCLUSION Graesslin's nomogram external validation demonstrates exportability and reproducibility. Importantly, the competing risk model analysis provides additional information for the design of prospective trials concerning the early diagnosis of BM and/or preventive treatment on high risk patients with extra-cerebral metastatic BC.
Collapse
Affiliation(s)
- Ludivine Genre
- Department of Gynecologic Surgery, IUCT-O, Toulouse, France
| | - Henri Roché
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Léonel Varela
- Department of Radiotherapy, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Dorra Kanoun
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Monia Ouali
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France.
| |
Collapse
|