Department of Breast Surgery, Kyorin University School of Medicine, Tokyo, Japan;
Department of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
Anticancer Res. 2024 Nov;44(11):5131-5138. doi: 10.21873/anticanres.17338.
BACKGROUND/AIM: To develop an accurate method to predict nodal pathological complete response (ypN0) in patients after neoadjuvant chemotherapy (NAC) for clinically node-positive breast cancer.
We included 128 patients with clinically node-positive primary breast cancer who underwent axillary lymph node dissection after NAC.
Breast primary tumor clinical complete response (ycT0) was observed in 29.7% and nodal clinical complete response (ycN0) in 44.5% of cases. When ycN0 was predicted as ypN0, the negative predictive value was 77.2%, and the false-negative rate was 19.7%. Estrogen receptor status, ycT0, and ycN0 were independent predictive factors for ypN0 after NAC in patients with clinically node-positive breast cancer. These factors were used to develop a nomogram for ypN0 prediction. The following points were added: 82 in case of estrogen receptor-negative, 56 in case of ycT0, and 100 in case of ycN0. Score summation was used to prognosticate the manifestation of ypN0. Our nomogram predicted ypN0 with a negative predictive value of 92.9% and false-negative rate of 4.5%, demonstrating an approximate 15% improvement over ypN0 prediction using ycN0 alone.
Estrogen receptor-negativity, ycT0, and ycN0 are independent predictive factors for ypN0 after NAC in clinically node-positive breast cancer. The nomogram may improve individualized axillary treatment.
背景/目的：开发一种准确的方法来预测临床淋巴结阳性乳腺癌患者新辅助化疗（NAC）后淋巴结病理完全缓解（ypN0）。
我们纳入了 128 例接受 NAC 后腋窝淋巴结清扫术的临床淋巴结阳性原发性乳腺癌患者。
29.7%的患者乳腺原发肿瘤临床完全缓解（ycT0），44.5%的患者淋巴结临床完全缓解（ycN0）。当 ycN0 预测为 ypN0 时，阴性预测值为 77.2%，假阴性率为 19.7%。雌激素受体状态、ycT0 和 ycN0 是临床淋巴结阳性乳腺癌患者 NAC 后预测 ypN0 的独立预测因素。这些因素被用于开发一个预测 ypN0 的列线图。以下几点被添加：雌激素受体阴性时加 82 分，ycT0 时加 56 分，ycN0 时加 100 分。通过评分总和来预测 ypN0 的表现。我们的列线图预测 ypN0 的阴性预测值为 92.9%，假阴性率为 4.5%，与单独使用 ycN0 预测 ypN0 相比，大约提高了 15%。
雌激素受体阴性、ycT0 和 ycN0 是临床淋巴结阳性乳腺癌患者 NAC 后预测 ypN0 的独立预测因素。该列线图可能改善个体化的腋窝治疗。
