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 |
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| Institution: | 1. Breast Unit, Department of Surgery, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy;2. Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università di Milano, Milan, Italy;3. Chirurgia Generale, Ospedale Centrale di Bolzano, Azienda Sanitaria dell''Alto Adige, Italy;4. Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;5. SSD Breast Unit, ASST-Settelaghi di Varese, Italy;6. Breast Unit Azienda Ospedaliero-Universitaria Policlinico Modena, Italy;7. Chirurgia Senologica, Ospedale Morgagni Pierantoni, Ausl Romagna, Forlì, Italy;8. Breast Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;9. Breast Surgery Unit, AUSL-IRCCS Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy;10. Service of Gynecology and Obstetrics, Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland;11. Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland;12. Breast Surgery, San Raffaele University and Research Hospital, Milano, Italy;13. Breast Cancer Centre, University Hospital of Pisa, Italy;14. Breast Surgery, Department of Surgery, ASST Fatebenefratelli Sacco, Milano, Italy;15. General Surgery I, Department of Surgery, ASST Fatebenefratelli Sacco, Milano, Italy;p. Università degli Studi di Pavia, Pavia, Italy |
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| Abstract: | BackgroundType 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 methods1950 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).ResultsIndependent 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.ConclusionThe 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. |
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| Keywords: | Breast cancer Neoadjuvant chemotherapy Axillary surgery Axillary dissection Sentinel node biopsy |
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