Department of Obstetrics and Gynecology (Pôle GYNORESP), Hôpital Tenon, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France.
Breast Cancer Res Treat. 2012 Apr;132(2):601-7. doi: 10.1007/s10549-011-1897-0. Epub 2011 Dec 9.
The aim of this study is to compare two published nomograms, the "Institut Gustave Roussy/M.D. Anderson Cancer Center" (IGR/MDACC) and the Colleoni nomograms, in predicting pathologic complete responses (pCR) to preoperative chemotherapy in an independent cohort and to assess the impact of HER2 status. Data from 200 patients with breast carcinoma treated with preoperative chemotherapy were collected. We calculated pCR rate predictions with the two nomograms and compared the predictions with the outcomes. Sixty percent of the patients with HER2-positive tumors received trastuzumab concomitantly with taxanes. Model performances were quantified with respect to discrimination and calibration. In the whole population, the area under the ROC curve (AUC) for the IGR/MDACC nomogram and the Colleoni nomogram were 0.74 and 0.75, respectively. Both of them underestimated the pCR rate (P = 0.026 and 0.0005). When patients treated with trastuzumab were excluded, the AUC were excellent: 0.78 for both nomograms with no significant difference between the predicted and the observed pCR (P = 0.14 and 0.15). When the specific population treated with trastuzumab preoperatively was analyzed, the AUC for the IGR/MDACC nomogram and the Colleoni nomogram were poor, 0.52 and 0.53, respectively. The IGR/MDACC and the Colleoni nomograms were accurate in predicting the probability of pCR after preoperative chemotherapy in the HER2-negative population but did not correctly predict pCR in the HER2-positive patients who received trastuzumab. This suggests that responses to preoperative chemotherapy, including trastuzumab, are biologically driven and that a specific nomogram or predictor for HER2-positive patients has to be developed.
这项研究的目的是比较两个已发表的列线图，即“Gustave Roussy 研究所/MD 安德森癌症中心”（IGR/MDACC）和 Colleoni 列线图，以预测独立队列中术前化疗的病理完全缓解（pCR）率，并评估 HER2 状态的影响。收集了 200 例接受术前化疗的乳腺癌患者的数据。我们使用这两个列线图计算了 pCR 率预测值，并将预测值与结果进行了比较。60%的 HER2 阳性肿瘤患者同时接受曲妥珠单抗和紫杉类药物治疗。使用判别和校准来量化模型性能。在整个人群中，IGR/MDACC 列线图和 Colleoni 列线图的 ROC 曲线下面积（AUC）分别为 0.74 和 0.75。两者都低估了 pCR 率（P=0.026 和 0.0005）。当排除接受曲妥珠单抗治疗的患者时，AUC 非常出色：两个列线图的 AUC 均为 0.78，预测与观察到的 pCR 之间无显著差异（P=0.14 和 0.15）。当分析接受术前曲妥珠单抗治疗的特定人群时，IGR/MDACC 列线图和 Colleoni 列线图的 AUC 分别为 0.52 和 0.53。IGR/MDACC 列线图和 Colleoni 列线图在预测 HER2 阴性人群接受术前化疗后的 pCR 概率方面是准确的，但不能正确预测接受曲妥珠单抗治疗的 HER2 阳性患者的 pCR。这表明，包括曲妥珠单抗在内的术前化疗反应是由生物学驱动的，需要为 HER2 阳性患者开发特定的列线图或预测器。
