Rouzier Roman, Pusztai Lajos, Garbay Jean-Remi, Delaloge Suzette, Hunt Kelly K, Hortobagyi Gabriel N, Berry Donald, Kuerer Henry M
Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2006 Oct 1;107(7):1459-66. doi: 10.1002/cncr.22177.
BACKGROUND: Neoadjuvant chemotherapy (NACT) increases the likelihood that breast conservation therapy for breast cancer patients will be successful. There is no available nomogram to predict breast conservation after NACT. The aim of the current study was to develop and validate nomograms for predicting residual tumor size and probability of a patient becoming eligible for breast conservation surgery after NACT. METHODS: A total of 1147 patients treated at M. D. Anderson Cancer Center (Houston, TX) and the Institut Gustave Roussy (Villejuif, France) who received anthracycline with or without paclitaxel NACT were included in the analysis. Clinicopathologic data from 1 series were used to construct logistic regression models for breast conservation and residual tumor size < 3 cm after NACT and were validated on an independent series. RESULTS: The discrimination and the calibration of the nomogram for predicting the probability of residual tumor size < 3 cm after anthracycline-based NACT were good when applied to the validation set (concordance index = 0.79; U-index = 10(-3)). The discrimination of the nomogram for predicting eligibility for breast conservation therapy was also good (concordance index = 0.67). However, the calibration had to be adjusted to take into account global rates of breast conservation surgery. A second nomogram adapted to preoperative chemotherapy regimens containing paclitaxel was established. The concordance index of the nomogram for predicting breast conservation was 0.71 (P < 10(-6)) for the independent dataset and the calibration was also good. The confrontation of both nomograms showed that predictions were highly correlated (r = 0.97), suggesting that eligibility for breast conservation therapy was independent of the preoperative chemotherapy regimen used. CONCLUSIONS: Nomograms were developed for breast cancer patients who received NACT to predict residual tumor size and whether the patient would thus become eligible for breast conservation therapy. These tools may be useful when counseling patients about treatment options, and a web-based interface is now available to help guide patients and physicians in these decisions.
背景：新辅助化疗（NACT）提高了乳腺癌患者保乳治疗成功的可能性。目前尚无用于预测NACT后保乳情况的列线图。本研究的目的是开发并验证用于预测NACT后残余肿瘤大小以及患者符合保乳手术条件概率的列线图。 方法：对在MD安德森癌症中心（德克萨斯州休斯顿）和古斯塔夫·鲁西研究所（法国维勒瑞夫）接受含或不含紫杉醇的蒽环类NACT治疗的1147例患者进行分析。来自1个系列的临床病理数据用于构建NACT后保乳及残余肿瘤大小<3 cm的逻辑回归模型，并在独立系列中进行验证。 结果：当应用于验证集时，基于蒽环类NACT预测残余肿瘤大小<3 cm概率的列线图的区分度和校准效果良好（一致性指数=0.79；U指数=10⁻³）。预测保乳治疗 eligibility的列线图的区分度也良好（一致性指数=0.67）。然而，必须对校准进行调整以考虑保乳手术的总体发生率。建立了第二个适用于含紫杉醇术前化疗方案的列线图。独立数据集预测保乳的列线图的一致性指数为0.71（P<10⁻⁶），校准效果也良好。两个列线图的对比显示预测高度相关（r=0.97），表明保乳治疗eligibility与所使用的术前化疗方案无关。 结论：为接受NACT的乳腺癌患者开发了列线图，以预测残余肿瘤大小以及患者是否因此符合保乳治疗条件。这些工具在为患者提供治疗选择咨询时可能有用，现在有一个基于网络的界面可帮助指导患者和医生做出这些决策。
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