对于细胞学证实腋窝淋巴结转移的激素受体阳性乳腺癌患者，术前新辅助化疗后腋窝淋巴结病理完全缓解的预测对于进一步治疗决策至关重要。
2020年7月25日，美国癌症学会《癌症》中国乳腺癌特刊在线发表复旦大学附属肿瘤医院郭瑢、苏永辉、司婧、薛静彦、杨犇龙、张琪、季玮儒、陈嘉健、迟亚云、邵志敏、吴炅等学者的研究报告，探讨了激素受体阳性乳腺癌细胞学证实腋窝淋巴结转移患者术前新辅助化疗后腋窝淋巴结病理完全缓解及其影响因素，并且建立了预测列线图，为这些患者术前新辅助化疗后优化腋窝处理提供了信息。
该单中心回顾研究对2007年11月～2017年3月复旦大学附属肿瘤医院前瞻收集的连续533例激素受体阳性乳腺癌细胞学证实腋窝淋巴结转移术前新辅助化疗患者数据进行回顾分析。通过多因素逻辑回归分析，随后构造并验证列线图。
结果，168例（31.5%）腋窝病理完全缓解，远多于103例（19.3%）乳腺病理完全缓解。
根据多因素逻辑回归分析，腋窝淋巴结病理完全缓解显著相关因素包括：
HER2阳性（P=0.004）
原发肿瘤缓解较好（P=0.001）
临床分期较早（P=0.045）
雌激素受体表达较低（P<0.001）
根据上述因素建立的列线图表明，训练集（演算组）受试者操作特征（真阳性率与假阴性率比值）曲线下面积达0.835（95%置信区间：0.778～0.892）。
验证集（验算组）区分度良好，受试者操作特征曲线下面积达0.753（95%置信区间：0.692～0.813）。
训练队列与验证队列的列线图一致性指数分别达0.834和0.756，表明列线图的校准度（标定度）良好。
因此，该研究结果表明，对于细胞学证实腋窝淋巴结转移的激素受体阳性乳腺癌患者，该列线图利用术前已知临床病理因素可以准确预测术前新辅助化疗后腋窝病理完全缓解，将有助于临床决策和临床研究设计。
Cancer. 2020 Aug 15;126 Suppl 16:3819-3829.
A nomogram for predicting axillary pathologic complete response in hormone receptor-positive breast cancer with cytologically proven axillary lymph node metastases.
Guo R, Su Y, Si J, Xue J, Yang B, Zhang Q, Chi W, Chen J, Chi Y, Shao Z, Wu J.
Fudan University Shanghai Cancer Center, Shanghai, China; Fudan University, Shanghai Medical College, Shanghai, China; Collaborative Innovation Center for Cancer Medicine, Shanghai, China.
BACKGROUND: The objective of this study was to determine an axillary pathologic complete response (pCR) and its influencing factors in patients with hormone receptor (HR)-positive breast cancer and cytologically proven axillary lymph node metastases. A prediction nomogram was established to provide information for the de-escalation of axillary management in these patients after neoadjuvant chemotherapy.
METHODS: The authors retrospectively enrolled all patients with HR-positive breast cancer in the neoadjuvant chemotherapy data set of Fudan University Shanghai Cancer Center. All data were prospectively collected. From 2007 to 2016, 533 consecutive patients were included. Multivariate logistic regression analysis was performed, after which a nomogram was constructed and validated.
RESULTS: An axillary pCR was achieved in 168 patients (31.5%), the which was much higher than the proportion of those who achieved a breast pCR (103 patients; 19.3%). Patients who had human epidermal growth factor receptor 2-positive disease (P = .004), a better primary tumor response (P = .001), earlier clinical stage (P = .045), and lower estrogen receptor expression (P < .001) were more likely to achieve a lymph node pCR. The nomogram indicated an area under the receiver operating characteristic curve (AUC) of 0.84 (95% CI, 0.78-0.89) in the training set. The validation set showed good discrimination with an AUC of 0.75 (95% CI, 0.69-0.81). The C-index was 0.834 and 0.756 in the training and validation cohort, respectively. The nomogram was well calibrated.
CONCLUSIONS: The authors developed and validated a nomogram for predicting axillary pCR in patients with HR-positive disease accurately by using clinicopathologic factors available before surgery. The model will facilitate logical clinical decision making and clinical trial design.
KEYWORDS: breast neoplasm; hormone receptor; lymph nodes; neoadjuvant therapy
PMID: 32710664
DOI: 10.1002/cncr.32830
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