Geng Rui, Min Ningning, Zheng Yiqiong, Hong Chenyan, Wu Rilige, Wu Huan, Wei Yufan, Zhang Yanjun, Li Xiru
Medical School of Chinese PLA: Chinese PLA General Hospital, Beijing, China.
Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Ann Transl Med. 2022 Jun;10(11):626. doi: 10.21037/atm-21-6738.
Accurately predicting outcomes for patients with breast cancer receiving neoadjuvant chemotherapy (NAC) is critical for clinical decisions. Prognostic models applicable to the Chinese population remain limited. The Neo-Bioscore staging system has been utilized as a predictive model for survival of breast cancer patients after NAC. This study aimed to validate the applicability of Neo-Bioscore in a Chinese population and develop an improved staging system based on it to predict prognosis of Chinese patients more accurately.
This study retrospectively collected clinicopathological and survival data in patients receiving NAC from February 2005 to August 2018 in PLA General Hospital. Discrimination, calibration and clinical usefulness were used to assess model performance. Univariate and multivariate analyses assessed relationships between clinicopathological factors and disease-specific survival. For model modification, postoperative pathological staging in the Neo-Bioscore was substituted with the posttreatment pathological tumor (ypT) stage and posttreatment pathological lymph node (ypN) stage. Neo-Bioscore and Modified Neo-Bioscore were compared with the American Joint Committee on Cancer (AJCC) staging system.
A total of 436 patients with a median follow-up of 67 months were included. Five-year disease-specific survival (DSS), overall survival, and disease-free survival rates were 88.0%, 87.9%, and 76.8%, respectively. The concordance index (C-index) of the Neo-Bioscore staging system, posttreatment pathological stage (PS), and pretreatment clinical stage (CS) for DSS were 0.78 [95% confidence interval (CI): 0.72-0.83], 0.75 (95% CI: 0.69-0.82), and 0.68 (95% CI: 0.62-0.74), respectively. No significant difference between the Neo-Bioscore and PS was observed in the C-index (P=0.399). ypT and ypN were included in Neo-Bioscore to replace PS and create a modified staging system named MNeo-Bioscore. The C-index for DSS of the MNeo-Bioscore was 0.82 (95% CI: 0.78-0.87), and the calibration curve and decision curve analysis (DCA) curve performed well in internal validation.
The Neo-Bioscore staging system provided precise prognostic stratification for Chinese breast cancer patients receiving NAC; ypN and ypT stage may be substituted for PS to add significant prognostic value for Neo-Bioscore.
准确预测接受新辅助化疗（NAC）的乳腺癌患者的预后对于临床决策至关重要。适用于中国人群的预后模型仍然有限。Neo-Bioscore分期系统已被用作预测NAC后乳腺癌患者生存的模型。本研究旨在验证Neo-Bioscore在中国人群中的适用性，并在此基础上开发一种改进的分期系统，以更准确地预测中国患者的预后。
本研究回顾性收集了2005年2月至2018年8月在中国人民解放军总医院接受NAC的患者的临床病理和生存数据。采用区分度、校准度和临床实用性来评估模型性能。单因素和多因素分析评估临床病理因素与疾病特异性生存之间的关系。为了进行模型修改，将Neo-Bioscore中的术后病理分期替换为治疗后病理肿瘤（ypT）分期和治疗后病理淋巴结（ypN）分期。将Neo-Bioscore和改良的Neo-Bioscore与美国癌症联合委员会（AJCC）分期系统进行比较。
共纳入436例患者，中位随访时间为67个月。5年疾病特异性生存（DSS）率、总生存率和无病生存率分别为88.0%、87.9%和76.8%。Neo-Bioscore分期系统、治疗后病理分期（PS）和治疗前临床分期（CS）对DSS的一致性指数（C指数）分别为0.78[95%置信区间（CI）：0.72-0.83]、0.75（95%CI：0.69-0.82）和0.68（95%CI：0.62-0.74）。Neo-Bioscore和PS在C指数上无显著差异（P=0.399）。将ypT和ypN纳入Neo-Bioscore以取代PS，并创建了一个改良的分期系统，称为MNeo-Bioscore。MNeo-Bioscore对DSS的C指数为0.82（95%CI：0.78-0.87），校准曲线和决策曲线分析（DCA）曲线在内部验证中表现良好。
Neo-Bioscore分期系统为接受NAC的中国乳腺癌患者提供了精确的预后分层；ypN和ypT分期可替代PS，为Neo-Bioscore增加显著的预后价值。
