Establishment and external validation of a prognostic model for predicting disease-free survival and risk stratification in breast cancer patients treated with neoadjuvant chemotherapy

Published on Aug 1, 2018in Cancer management and research3.989
路 DOI :10.2147/CMAR.S171129
Jianguo Lai4
Estimated H-index: 4
(SYSU: Sun Yat-sen University),
Hongli Wang4
Estimated H-index: 4
(SYSU: Sun Yat-sen University)
+ 2 AuthorsZihao Pan5
Estimated H-index: 5
(SYSU: Sun Yat-sen University)
Sources
Abstract
Background: The eighth edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system for survival prediction and risk stratification in breast cancer (BC) patients after neoadjuvant chemotherapy (NCT) is of limited efficacy. This study aimed to establish a novel prognostic nomogram for predicting disease-free survival (DFS) in BC patients after NCT. Patients and methods: A total of 567 BC patients treated with NCT, from two independent centers, were included in this study. Cox proportional-hazards regression (CPHR) analysis was conducted to identify the independent prognostic factors for DFS, in order to develop a model. Subsequently, the discrimination and calibration ability of the prognostic model were assessed in terms of its concordance index (C-index), risk group stratification, and calibration curve. The performance of the nomogram was compared with that of the eighth edition of the AJCC TNM staging system via C-index. Results: Based on the CPHR model, eight prognostic predictors were screened and entered into the nomogram. The prognostic model showed better performance (p<0.01) in terms of DFS prediction (C-index: 0.738; 95% CI: 0.698-0.779) than the eighth edition of the AJCC TNM staging system (C-index: 0.644; 95% CI: 0.604-0.684). Stratification into three risk groups highlighted significant differences between the survival curves in the training cohort and those in the validation cohort. The calibration curves for likelihood of 3- and 5-year DFS indicated optimal agreement between nomogram predictions and actual observations. Conclusion: We constructed and externally validated a novel nomogram scoring system for individualized DFS estimation in BC patients treated with NCT. This user-friendly predictive tool may help oncologists to make optimal clinical decisions.
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References32
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Purpose Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC).
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#2William E. BarlowH-Index: 85
Last. Jo Anne ZujewskiH-Index: 29
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Summary Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisatio...
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#1Chang-Hsien Lu (Memorial Hospital of South Bend)H-Index: 10
#2Chien-Ting Liu (Memorial Hospital of South Bend)H-Index: 8
Last. Wen-Chi Chou (CGU: Chang Gung University)H-Index: 20
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Objectives: Prediction of recurrent risk in patients with major salivary gland carcinoma (MSGC) after surgical treatment is an important but difficult task because of a broad spectrum of tumor histological subtypes and diverse clinical behaviors. This study aimed to develop and validate a nomogram to predict the recurrent probability in patients with MSGC. Methods: A total of 231 consecutive patients with MSGC received curative-intend surgery between 2002 and 2014 from one medical center were se...
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#1Audree B. Tadros (University of Texas MD Anderson Cancer Center)H-Index: 8
#2Wei T. Yang (University of Texas MD Anderson Cancer Center)H-Index: 19
Last. Henry Mark KuererH-Index: 112
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Importance A pathologic complete response (pCR; no invasive or in situ cancer) occurs in 40% to 50% of patients with HER2 -positive ( HER2 +) and triple-negative (TN) breast cancer. The need for surgery if percutaneous biopsy of the breast after neoadjuvant chemotherapy (NCT) indicates pCR in the breast (hereinafter referred to as breast pCR) has been questioned, and appropriate management of the axilla in such patients is unknown. Objective To identify patients among exceptional responders to N...
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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistic...
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#1Ping Zhou (Southern Medical University)H-Index: 3
#2Yi Zhou Jiang (Fudan University)H-Index: 23
Last. Zhi Ming ShaoH-Index: 42
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Objective The aim of this study was to describe the clinical features and outcomes of Chinese patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer.
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#1Shannon K. Swisher (University of Texas MD Anderson Cancer Center)H-Index: 2
#2Jose Vila (University of Texas MD Anderson Cancer Center)H-Index: 10
Last. Elizabeth A. Mittendorf (University of Texas MD Anderson Cancer Center)H-Index: 71
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Background Our group previously published data showing that patients could be stratified by constructed molecular subtype with respect to locoregional recurrence (LRR)-free survival after neoadjuvant chemotherapy and breast-conserving therapy (BCT). That study predated use of trastuzumab for human epidermal growth factor receptor 2 (HER2)-positive patients. The current study was undertaken to determine the impact of subtype and response to therapy in a contemporary cohort.
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Abstract This study aimed to establish an effective prognostic nomogram with or without plasma Epstein-Barr virus DNA (EBV DNA) for nondisseminated nasopharyngeal carcinoma (NPC). The nomogram was based on a retrospective study of 4630 patients who underwent radiotherapy with or without chemotherapy at Sun Yat-sen University Cancer Center from 2007 to 2009. The predictive accuracy and discriminative ability of the nomogram were determined by a concordance index (C-index) and calibration curve an...
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#1Wanqing ChenH-Index: 59
#2Rongshou ZhengH-Index: 47
Last. Siwei ZhangH-Index: 54
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The National Central Cancer Registry (NCCR) of China collected population-based cancer registration data from all cancer registries in China. This study aimed to compile national cancer incidences and mortalities in 2011 and estimate cancer incident new cases and cancer deaths. In 2014, there were 234 cancer registries that submitted records of new cancer cases and cancer deaths that occurred in 2011 to the NCCR. All datasets were evaluated based on the criteria of data quality of the NCCR. The ...
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#1Mehra Golshan (Harvard University)H-Index: 40
#2Constance Cirrincione (Duke University)H-Index: 43
Last. David W. Ollila (UNC: University of North Carolina at Chapel Hill)H-Index: 49
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Triple negative breast cancer (TNBC) is characterized by absent or minimal expression of estrogen (ER) and progesterone receptor and human epidermal growth factor receptor 2 (HER2). TNBC accounts for 15% of invasive breast cancers diagnosed in the United States, and is more common in younger women, African Americans, Hispanics, and BRCA1 mutation carriers. To determine the biologic interaction of systemic agents with the disease, neoadjuvant systemic therapy (NST) has been employed with increasi...
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#1Srivarshini Cherukupalli Mohan (Cedars-Sinai Medical Center)H-Index: 1
#2Sarah Walcott-SappH-Index: 3
Last. Alice P. Chung (Cedars-Sinai Medical Center)H-Index: 6
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Introduction Biomarker changes in patients with residual disease (RD) after neoadjuvant systemic therapy (NAT) have unclear consequences. This study examined the prevalence of biomarker [hormone receptor (HR) and HER2] change and its effect on disease-free survival (DFS) and overall survival (OS). Patients and methods A total of 303 patients treated with NAT from 2008 to 2016 were identified from a prospective database. Biomarker status at diagnosis was determined and retested after NAT in patie...
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#1Rongyun Mai (Guangxi Medical University)H-Index: 6
#3Wei-da Meng (Guangxi Medical University)H-Index: 1
Last. Tao Bai (Guangxi Medical University)H-Index: 12
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BACKGROUND The accurate prediction of post-hepatectomy early recurrence (PHER) of hepatocellular carcinoma (HCC) is vital in determining postoperative adjuvant treatment and monitoring. This study aimed to develop and validate an artificial neural network (ANN) model to predict PHER in HCC patients without macroscopic vascular invasion. METHODS Nine hundred and three patients who underwent curative liver resection for HCC participated in this study. They were randomly divided into derivation (n鈥...
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#1Rongyun Mai (Guangxi Medical University)H-Index: 6
#2Jie Zeng (Guangxi Medical University)H-Index: 1
Last. Jiazhou Ye (Guangxi Medical University)H-Index: 13
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BACKGROUND: Accurate preoperative assessment of hepatic functional reserve is essential for conducting a safe hepatectomy. In recent years, aspartate aminotransferase-to-platelet ratio index (APRI) has been used as a noninvasive model for assessing fibrosis stage, hepatic functional reserve, and prognosis after hepatectomy with a high level of accuracy. The purpose of this research was to evaluate the clinical value of combining APRI with standardized future liver remnant (sFLR) for predicting s...
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#1Dong Song (JLU: Jilin University)H-Index: 6
#2Xiaxia Man (JLU: Jilin University)H-Index: 2
Last. Ye DuH-Index: 7
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Neoadjuvant chemotherapy (NAC) may increase the resection rate of breast cancer and shows promising effects on patient prognosis. It has become a necessary treatment choice and is widely used in the clinical setting. Benefitting from the clinical information obtained during NAC treatment, computational methods can improve decision-making by evaluating and predicting treatment responses using a multidisciplinary approach, as there are no uniformly accepted protocols for all institutions for adopt...
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#1Jianguo Lai (Academy of Medical Sciences, United Kingdom)H-Index: 4
#2Bo Chen (Academy of Medical Sciences, United Kingdom)H-Index: 4
Last. Ning Liao (Peking Union Medical College)H-Index: 7
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Accumulating evidence has demonstrated that immune-related lncRNAs (IRLs) are commonly aberrantly expressed in breast cancer (BC). Thus, we aimed to establish an IRL-based tool to improve prognosis prediction in BC patients. We obtained IRL expression profiles in large BC cohorts (N鈥=鈥911) from The Cancer Genome Atlas (TCGA) database. Then, in light of the correlation between each IRL and recurrence-free survival (RFS), we screened prognostic IRL signatures to construct a novel RFS nomogram via ...
Source
#1Shuai YanH-Index: 1
#2Wenjie WangH-Index: 1
Last. Weiyang TaoH-Index: 1
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Purpose Pathological complete response (pCR) is the goal of neoadjuvant chemotherapy (NAC) for the HER2-positive and triple-negative subtypes of breast cancer and is related to survival benefit; however, luminal breast cancer is not sensitive to NAC, and the size of tumor shrinkage is a more meaningful clinical indicator for the luminal breast cancer subtype. We wanted to use a nomogram or formula to develop and implement a series of prediction models for pCR or tumor shrinkage size. Patients an...
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#6Yan Zhao (PRC: China Medical University (PRC))H-Index: 5
Objective: There are controversial indications for neoadjuvant chemotherapy (NAT) in the treatment of locally advanced gastric cancer (LAGC). Here, we aimed to identify indications for NAT based on pre-treatment clinicopathological and laboratory parameters. Methods: This study included a retrospective cohort of 1083 LAGC patients who had underwent radical D2 gastrectomy in the Cancer Hospital of China Medical University between 2012 and 2016. After propensity score matching, 756 patients were r...
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Purpose To evaluate the prognostic effect of the integration of genomic and transcriptomic profiles in breast cancer.
Source
#1Stephen B. EdgeH-Index: 80
#2Gabriel N. Hortobagyi (University of Texas MD Anderson Cancer Center)H-Index: 192
Last. Armando E. Giuliano (Cedars-Sinai Medical Center)H-Index: 103
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ABSTRACTIntroduction: Cancer staging has historically been based solely on the anatomic extent of the tumor (T), spread to lymph nodes (N), and the presence of distant metastases (M). More recently biologic factors have been added to modify TNM stage groups to provide more accurate prognosis for patients.Areas covered: The American Joint Committee on Cancer (AJCC) updated breast cancer staging in 2016 to include T, N, M, tumor grade and expression of estrogen and progesterone receptors and HER2....
Source
#1Jianguo Lai (SYSU: Sun Yat-sen University)H-Index: 4
#2Zihao Pan (SYSU: Sun Yat-sen University)H-Index: 5
Last. Fengxi Su (SYSU: Sun Yat-sen University)H-Index: 34
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Objective: Over the past decade, several studies have highlighted that axillary lymph node ratio (ratio of involved over excised axillary lymph nodes) was a superior predictor for survival outcomes compared with ypN staging. Thus, this study aimed to integrate the prognostic value of axillary lymph node ratio to improve individualized prediction of survival in node-positive breast cancer patients after neoadjuvant chemotherapy. Methods: A clinical data of 339 node-positive breast cancer patients...
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