Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan.
Department of Pathology, Toranomon Hospital, Tokyo, Japan.
Breast Cancer. 2024 Nov;31(6):1018-1027. doi: 10.1007/s12282-024-01616-z. Epub 2024 Jul 17.
Chemotherapy is crucial for hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, and its survival benefits may outweigh adverse events. Oncotype DX (ODX) assesses this balance; however, it is expensive. Using nomograms to identify cases requiring ODX may be economically beneficial. We aimed to identify clinicopathological variables that correlated with the recurrence score (RS) and develop a nomogram that predicted the RS.
We included 457 patients with estrogen receptor-positive, HER2-negative breast cancer with metastases in fewer than four axillary lymph nodes who underwent surgery and ODX at our hospital between 2007 and 2023. We developed nomograms and internally validated them in 310 patients who underwent surgery between 2007 and 2021 and validated the model's performance in 147 patients who underwent surgery between 2022 and 2023.
Logistic regression analysis revealed that progesterone receptor (PgR) level, histological grade (HG), and Ki67 index independently predicted the RS. A nomogram was developed using these variables to predict the RS (area under the curve [AUC], 0.870; 95% confidence interval [CI], 0.82-0.92). The nomogram was applied to the model validation group (AUC, 0.877; 95% CI, 0.80-0.95). When the sensitivity of the nomogram was 90%, the model was able to identify 52.3% low-RS and 41.2% high-RS cases not requiring ODX.
This was the first nomogram model developed based on data from a cohort of Japanese women. It may help determine the indications for ODX and the use of nomogram to identify cases requiring ODX may be economically beneficial.
化疗对于激素受体阳性、人表皮生长因子受体 2（HER2）阴性乳腺癌至关重要，其生存获益可能超过不良反应。Oncotype DX（ODX）评估这种平衡；然而，它是昂贵的。使用列线图来识别需要 ODX 的病例可能具有经济效益。我们旨在确定与复发评分（RS）相关的临床病理变量，并开发一种预测 RS 的列线图。
我们纳入了 457 例在少于 4 个腋窝淋巴结中发生转移的雌激素受体阳性、HER2 阴性乳腺癌患者，这些患者在我们医院于 2007 年至 2023 年间接受了手术和 ODX。我们在 2007 年至 2021 年间接受手术的 310 例患者中开发了列线图，并对其进行了内部验证，并在 2022 年至 2023 年间接受手术的 147 例患者中验证了该模型的性能。
Logistic 回归分析显示，孕激素受体（PgR）水平、组织学分级（HG）和 Ki67 指数独立预测了 RS。使用这些变量开发了一个列线图来预测 RS（曲线下面积 [AUC]，0.870；95%置信区间 [CI]，0.82-0.92）。该列线图应用于模型验证组（AUC，0.877；95%CI，0.80-0.95）。当列线图的灵敏度为 90%时，该模型能够识别出 52.3%的低 RS 和 41.2%的不需要 ODX 的高 RS 病例。
这是第一个基于日本女性队列数据开发的列线图模型。它可能有助于确定 ODX 的适应证，并且使用列线图来识别需要 ODX 的病例可能具有经济效益。
