Validation of a Novel Nomogram for Prediction of Local Relapse after Surgery for Invasive Breast Carcinoma.
Adult
Aged
Breast Neoplasms
/ pathology
Carcinoma, Ductal, Breast
/ pathology
Carcinoma, Lobular
/ pathology
Europe
/ epidemiology
Female
Follow-Up Studies
Humans
Incidence
Mastectomy
/ methods
Mastectomy, Segmental
/ methods
Middle Aged
Neoplasm Recurrence, Local
/ diagnosis
Nomograms
Prognosis
Retrospective Studies
Risk Factors
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
02
09
2019
pubmed:
23
1
2020
medline:
3
2
2021
entrez:
23
1
2020
Statut:
ppublish
Résumé
Around 7% of women who undergo breast-conserving surgery (BCS) or mastectomy are at risk of developing ipsilateral breast tumor recurrence (IBTR). When assessing risks that, like that of IBTR, depend on multiple clinicopathological variables, nomograms are the predictive tools of choice. In this study, two independent nomograms were constructed to estimate the individualized risk of IBTR after breast surgery. In this retrospective study, 18,717 consecutive patients with primary invasive breast cancer were enrolled. The training set used for building the nomograms comprised 15,124 patients (11,627 treated with BCS and 3497 with mastectomy), while the validation set included 3593 women (2565 BCS and 1028 mastectomy). Median follow-up time was 8 years in the training set and 6 years in the validation set. Multivariable Cox proportional hazards regression was used to identify independent factors for IBTR. Two separated nomograms were constructed on multivariate models for BCS and mastectomy. The factors that associated with IBTR after either BCS or mastectomy were identified. The two multivariable models were used to build nomograms for the prediction of IBTR 1 year, 5 years, and 10 years after BCS or after mastectomy. Five-year and 10-year IBTR rates in the BCS training set were equal to 3.50% and 7.00%, respectively, and to 5.39% and 7.94% in the mastectomy training set. The nomograms were subsequently validated with c-index values of 0.77 and 0.69 in the BCS and mastectomy validation sets, respectively. The nomograms presented in this study provide clinicians and patients with a valuable decision-making tool for choosing between different treatment options for invasive breast cancer.
Sections du résumé
BACKGROUND
BACKGROUND
Around 7% of women who undergo breast-conserving surgery (BCS) or mastectomy are at risk of developing ipsilateral breast tumor recurrence (IBTR). When assessing risks that, like that of IBTR, depend on multiple clinicopathological variables, nomograms are the predictive tools of choice. In this study, two independent nomograms were constructed to estimate the individualized risk of IBTR after breast surgery.
PATIENTS AND METHODS
METHODS
In this retrospective study, 18,717 consecutive patients with primary invasive breast cancer were enrolled. The training set used for building the nomograms comprised 15,124 patients (11,627 treated with BCS and 3497 with mastectomy), while the validation set included 3593 women (2565 BCS and 1028 mastectomy). Median follow-up time was 8 years in the training set and 6 years in the validation set. Multivariable Cox proportional hazards regression was used to identify independent factors for IBTR. Two separated nomograms were constructed on multivariate models for BCS and mastectomy.
RESULTS
RESULTS
The factors that associated with IBTR after either BCS or mastectomy were identified. The two multivariable models were used to build nomograms for the prediction of IBTR 1 year, 5 years, and 10 years after BCS or after mastectomy. Five-year and 10-year IBTR rates in the BCS training set were equal to 3.50% and 7.00%, respectively, and to 5.39% and 7.94% in the mastectomy training set. The nomograms were subsequently validated with c-index values of 0.77 and 0.69 in the BCS and mastectomy validation sets, respectively.
CONCLUSIONS
CONCLUSIONS
The nomograms presented in this study provide clinicians and patients with a valuable decision-making tool for choosing between different treatment options for invasive breast cancer.
Identifiants
pubmed: 31965372
doi: 10.1245/s10434-019-08160-7
pii: 10.1245/s10434-019-08160-7
pmc: PMC7523878
mid: NIHMS1615580
doi:
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1864-1874Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Références
Corso G, Maisonneuve P, Santomauro GI, et al. Ipsilateral breast tumor reappearance and contralateral breast cancer after primary breast cancer treatment: a comprehensive retrospective study of 15,168 patients. Oncology. 2018;95:147–55.
doi: 10.1159/000488764
Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol. 2016;34:4040–6.
doi: 10.1200/JCO.2016.68.3573
Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010;46:3219–32.
doi: 10.1016/j.ejca.2010.07.043
Abdulkarim BS, Cuartero J, Hanson J, et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. J Clin Oncol. 2011;29:2852–8.
doi: 10.1200/JCO.2010.33.4714
Freedman GM, Fowble BL. Local recurrence after mastectomy or breast-conserving surgery and radiation. Oncology (Williston Park). 2000;14:1561–81. (discussion 81-2, 82-4).
Millar EK, Graham PH, O’Toole SA, et al. Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel. J Clin Oncol. 2009;27:4701–8.
doi: 10.1200/JCO.2008.21.7075
Nguyen PL, Taghian AG, Katz MS, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol. 2008;26:2373–8.
doi: 10.1200/JCO.2007.14.4287
Fisher B, Anderson S, Redmond CK. Surgery for early breast cancer. N Engl J Med. 1996;334:987–8.
doi: 10.1056/NEJM199606273342603
Fisher B, Dignam J, Mamounas EP, et al. Sequential methotrexate and fluorouracil for the treatment of node-negative breast cancer patients with estrogen receptor-negative tumors: eight-year results from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-13 and first report of findings from NSABP B-19 comparing methotrexate and fluorouracil with conventional cyclophosphamide, methotrexate, and fluorouracil. J Clin Oncol. 1996;14:1982–92.
doi: 10.1200/JCO.1996.14.7.1982
Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24:2028–37.
doi: 10.1200/JCO.2005.04.3273
Luo C, Zhong X, Deng L, et al. Nomogram predicting locoregional recurrence to assist decision-making of postmastectomy radiation therapy in patients with T1-2N1 breast cancer. Int J Radiat Oncol Biol Phys. 2019;103:905–12.
doi: 10.1016/j.ijrobp.2018.11.005
Mamounas EP, Liu Q, Paik S, et al. 21-Gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst. 2017;109:1–8.
doi: 10.1093/jnci/djw259
Mamounas EP, Tang G, Fisher B, et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol. 2010;28:1677–83.
doi: 10.1200/JCO.2009.23.7610
Rouzier R, Pusztai L, Delaloge S, et al. Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol. 2005;23:8331–9.
doi: 10.1200/JCO.2005.01.2898
Fujii T, Kogawa T, Wu J, et al. Nomogram to predict pathologic complete response in HER2-positive breast cancer treated with neoadjuvant systemic therapy. Br J Cancer. 2017;116:509–14.
doi: 10.1038/bjc.2016.444
Rudloff U, Jacks LM, Goldberg JI, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28:3762–9.
doi: 10.1200/JCO.2009.26.8847
Tavassoli FA, Devilee P. Pathology and genetics of tumours of the breast and female genital organs: WHO Classification of Tumour Series. Lyon: IARC; 2003. p. 13–48.
Colleoni M, Bagnardi V, Rotmensz N, et al. A risk score to predict disease-free survival in patients not achieving a pathological complete remission after preoperative chemotherapy for breast cancer. Ann Oncol. 2009;20:1178–84.
doi: 10.1093/annonc/mdn747
Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. C. W. Elston & I. O. Ellis. Histopathology 1991; 19; 403–10. Histopathology. 2002;41:151–2. (discussion 2-3).
Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–47.
doi: 10.1093/annonc/mdr304
Hugh J, Hanson J, Cheang MC, et al. Breast cancer subtypes and response to docetaxel in node-positive breast cancer: use of an immunohistochemical definition in the BCIRG 001 trial. J Clin Oncol. 2009;27:1168–76.
doi: 10.1200/JCO.2008.18.1024
The R Project for Statistical Computing. http://www.r-project.org/ . Accessed 14 June 2019
Brennan MF, Kattan MW, Klimstra D, et al. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.
doi: 10.1097/01.sla.0000133125.85489.07
Kattan MW, Scardino PT. Evidence for the usefulness of nomograms. Nat Clin Pract Urol. 2007;4:638–9.
doi: 10.1038/ncpuro0968
Voelkel V, Draeger T, Groothuis-Oudshoorn CGM, et al. Predicting the risk of locoregional recurrence after early breast cancer: an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany. J Cancer Res Clin Oncol. 2019;145:1823–33.
doi: 10.1007/s00432-019-02904-4
Weiser MR, Landmann RG, Kattan MW, et al. Individualized prediction of colon cancer recurrence using a nomogram. J Clin Oncol. 2008;26:380–5.
doi: 10.1200/JCO.2007.14.1291
Bevilacqua JL, Kattan MW, Fey JV, et al. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol. 2007;25:3670–9.
doi: 10.1200/JCO.2006.08.8013
Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–51.
doi: 10.1245/ASO.2003.03.015
Early Breast Cancer Trialists’ Collaboration Group (EBCTCG), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383:2127–35.
doi: 10.1016/S0140-6736(14)60488-8
Zeidan YH, Habib JG, Ameye L, et al. Postmastectomy radiation therapy in women with T1–T2 Tumors and 1 to 3 positive lymph nodes: analysis of the Breast International Group 02-98 Trial. Int J Radiat Oncol Biol Phys. 2018;101:316–24.
doi: 10.1016/j.ijrobp.2018.01.105