Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China.
Department of Breast Disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road, Zhengzhou, 450008, Henan Province, China.
J Cancer Res Clin Oncol. 2023 Sep;149(11):8769-8778. doi: 10.1007/s00432-023-04817-9. Epub 2023 May 2.
The prediction of axillary lymph node status after neoadjuvant chemotherapy (NAC) becoming critical because of the advocation of the de-escalation of axillary management. We investigate associated factors of axillary upstaging in clinical node-negative (cN0) breast cancer patients receiving NAC to develop and validate an accurate prediction nomogram.
We retrospectively analyzed 1892 breast cancer patients with stage of cT1-3N0 treated by NAC and subsequent surgery between 2010 and 2020 in twenty hospitals across China. Patients randomly divided into a training set and validation set (3:1). Univariate and multivariate logistic regression analysis were performed, after which a nomogram was constructed and validated.
In total, pathologic node negativity (ypN0) achieved in 1406 (74.3%) patients and another 486 (25.7%) patients upstaged to pathologic node positive (ypN+). Breast pathologic complete response (bpCR) was achieved in 445 (23.5%) patients and non-bpCR in 1447 (76.5%) patients. A nomogram was established by ER, tumor histology, HER2 status, cycle of NAC treatment, and the bpCR, which were confirmed by multivariate logistic analysis as independent predictors of nodal upstaging in the training cohort (n = 1419). The area under the receiver operating characteristic curve (AUC) of the training cohort and validation cohort (n = 473) were 0.73 (95% CI 0.693-0.751) and 0.77 (95% CI 0.723-0.812) respectively.
We present a nomogram with a nationwide large sample data which can effectively predict axillary upstaging after neoadjuvant chemotherapy to give better advice for individualized axillary lymph node management of breast cancer.
新辅助化疗（NAC）后腋窝淋巴结状态的预测变得至关重要，因为提倡降低腋窝管理的级别。我们研究了接受 NAC 的临床淋巴结阴性（cN0）乳腺癌患者腋窝升级的相关因素，以开发和验证准确的预测列线图。
我们回顾性分析了 2020 年在中国 20 家医院接受 NAC 治疗和随后手术的 1892 例 cT1-3N0 期乳腺癌患者。患者随机分为训练集和验证集（3:1）。进行单因素和多因素逻辑回归分析，然后构建并验证列线图。
共有 1406 例（74.3%）患者达到病理淋巴结阴性（ypN0），另有 486 例（25.7%）患者升级为病理淋巴结阳性（ypN+）。1447 例（76.5%）患者未达到乳腺病理完全缓解（bpCR），445 例（23.5%）患者达到 bpCR。通过多因素逻辑回归分析，我们建立了一个由 ER、肿瘤组织学、HER2 状态、NAC 治疗周期和 bpCR 组成的列线图，这些因素被证实是训练队列中淋巴结升级的独立预测因素（n=1419）。训练队列（n=1419）和验证队列（n=473）的受试者工作特征曲线下面积（AUC）分别为 0.73（95%CI 0.693-0.751）和 0.77（95%CI 0.723-0.812）。
我们提出了一个具有全国性大样本数据的列线图，可以有效地预测新辅助化疗后腋窝淋巴结的升级，为乳腺癌个体化腋窝淋巴结管理提供更好的建议。
