Abstract
Nodal staging in breast cancer is a key predictor of prognosis. This paper presents the results of potential clinicopathological predictors of axillary lymph node involvement and develops an efficient prediction model to assist in predicting axillary lymph node metastases. Seventy patients with primary early breast cancer who underwent axillary dissection were evaluated. Univariate and multivariate logistic regression were performed to evaluate the association between clinicopathological factors and lymph node metastatic status. A logistic regression predictive model was built from 50 randomly selected patients; the model was also applied to the remaining 20 patients to assess its validity. Univariate analysis showed a significant relationship between lymph node involvement and absence of nm-23 (p = 0.010) and Kiss-1 (p = 0.001) expression. Absence of Kiss-1 remained significantly associated with positive axillary node status in the multivariate analysis (p = 0.018). Seven clinicopathological factors were involved in the multivariate logistic regression model: menopausal status, tumor size, ER, PR, HER2, nm-23 and Kiss-1. The model was accurate and discriminating, with an area under the receiver operating characteristic curve of 0.702 when applied to the validation group. Moreover, there is a need discover more specific candidate proteins and molecular biology tools to select more variables which should improve predictive accuracy.
Highlights
Axillary lymph node metastasis is one of the most important prognostic determinants for patients with breast cancer [1]
Procedures have been less relevant in treatment selection because of the introduction of sentinel lymph node biopsy (SLNB) [4], which offers information on the axillary lymph node status with significantly lower morbidity compared to that associated with Axillary lymph node dissection (ALND) [5]
Fifty patients were randomly selected for the modeling group, the other 20 patients were placed in the validation group
Summary
Axillary lymph node metastasis is one of the most important prognostic determinants for patients with breast cancer [1]. Axillary lymph node dissection (ALND) had been the standard staging and therapeutic procedure for many years. There are significant short- and long-term morbidities after ALND, including arm lymphedema, shoulder range of motion (ROM) impairment, pain, and numbness or paresthesias [2,3]. The proportion of node involvement patients has been constantly decreasing as breast cancer is more often diagnosed at an early stage. The morbidity after SLN biopsy is not negligible; lymphedema and impaired shoulder range of motion remain a clinically relevant sequela after SLNB [6,7]. Many patients with positive SLNs do not show other axillary lymph node metastasis. According to the ACOSOG-011 data, among patients with limited
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