用于预测接受新辅助全身治疗的HER2阳性乳腺癌病理完全缓解的列线图。
Nomogram to predict pathologic complete response in HER2-positive breast cancer treated with neoadjuvant systemic therapy.
作者信息
Fujii Takeo, Kogawa Takahiro, Wu Jimin, Sahin Aysegul A, Liu Dian D, Chavez-MacGregor Mariana, Giordano Sharon H, Raghavendra Akshara, Murthy Rushmy K, Tripathy Debu, Shen Yu, Yamal Jose-Miguel, Ueno Naoto T
机构信息
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
Department of Biostatistics, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, Texas 77030, USA.
出版信息
Br J Cancer. 2017 Feb 14;116(4):509-514. doi: 10.1038/bjc.2016.444. Epub 2017 Jan 12.
BACKGROUND
Pathologic complete response (pCR) is associated with improved survival outcomes in patients with HER2-positive primary breast cancer. We developed a nomogram to predict the probability of pCR rates by using oestrogen receptor (ER) expression, progesterone receptor (PR) expression and HER2/CEP17 ratio as continuous variables.
METHODS
We retrospectively reviewed patients with stages I-III HER2-positive invasive breast cancer who had definitive surgery in 1999-2015 and received neoadjuvant systemic therapy (NST). Multivariate logistic regression models were applied to assess the effect of variables on pCR. A nomogram was built to estimate the probability of pCR. The discriminative ability was estimated by the concordance index (C-index). The accuracy was assessed graphically with a calibration curve.
RESULTS
A total of 793 patients were included in the analysis. Low ER expression (P<0.001), high HER2/CEP12 ratio (P=0.03), and non-inflammatory breast cancer subtype (P=0.003) were associated with increased pCR rates. Regimens containing trastuzumab or trastuzumab and pertuzumab were associated with higher pCR rates than cytotoxic agents alone (P<0.001 and P<0.001, respectively). The C-index was 0.69. The calibration curve showed good agreement.
CONCLUSIONS
Our nomogram predicted the pCR rate after NST among patients with HER2-positive primary breast cancer using clinicopathologic factors.
背景
病理完全缓解（pCR）与HER2阳性原发性乳腺癌患者生存结局的改善相关。我们开发了一种列线图，通过将雌激素受体（ER）表达、孕激素受体（PR）表达和HER2/CEP17比值作为连续变量来预测pCR率的概率。
方法
我们回顾性分析了1999年至2015年期间接受根治性手术并接受新辅助全身治疗（NST）的I-III期HER2阳性浸润性乳腺癌患者。应用多变量逻辑回归模型评估各变量对pCR的影响。构建列线图以估计pCR的概率。通过一致性指数（C指数）评估判别能力。用校准曲线以图形方式评估准确性。
结果
共有793例患者纳入分析。低ER表达（P<0.001）、高HER2/CEP12比值（P=0.03）和非炎性乳腺癌亚型（P=0.003）与pCR率增加相关。含曲妥珠单抗或曲妥珠单抗和帕妥珠单抗的方案比单独使用细胞毒性药物的pCR率更高（分别为P<0.001和P<0.001）。C指数为0.69。校准曲线显示一致性良好。
结论
我们的列线图使用临床病理因素预测了HER2阳性原发性乳腺癌患者NST后的pCR率。
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