Abstract
BackgroundOur goal is to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stanford Online Calculator (SOC) for predicting non-sentinel lymph node (NSLN) metastasis in Chinese patients, and develop a new model for better prediction of NSLN metastasis.MethodsThe MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients. Univariate and multivariate analyses were performed to evaluate the relationship between NSLN metastasis and clinicopathologic factors, using the medical records of the first 80 breast cancer patients. A new model predicting NSLN metastasis was developed from the 80 patients.ResultsThe MSKCC and SOC predicted NSLN metastasis in a series of 120 patients with an area under the receiver operating characteristic curve (AUC) of 0.688 and 0.734, respectively. For predicted probability cut-off points of 10%, the false-negative (FN) rates of MSKCC and SOC were both 4.4%, and the negative predictive value (NPV) 75.0% and 90.0%, respectively. Tumor size, Kiss-1 expression in positive SLN and size of SLN metastasis were independently associated with NSLN metastasis (p<0.05). A new model (Peking University People's Hospital, PKUPH) was developed using these three variables. The MSKCC, SOC and PKUPH predicted NSLN metastasis in the second 40 patients from the 120 patients with an AUC of 0.624, 0.679 and 0.795, respectively.ConclusionMSKCC nomogram and SOC did not perform as well as their original researches in Chinese patients. As a new predictor, Kiss-1 expression in positive SLN correlated independently with NSLN metastasis strongly. PKUPH model achieved higher accuracy than MSKCC and SOC in predicting NSLN metastasis in Chinese patients.
Highlights
Sentinel lymph node biopsy (SLNB) has taken the place of axillary lymph node dissection (ALND) in early stage breast carcinoma and its benefits in terms of morbidity have been well established [1]
Study patients We reviewed 120 consecutive, clinically lymph node negative breast cancer patients with positive sentinel lymph node (SLN)(s) who underwent completion ALND from January 2009 through December 2012 at the Breast Disease Center, Peking University People's Hospital (PKUPH)
Compared with the Memorial Sloan-Kettering Cancer Center (MSKCC) [11] and Stanford studies [12], difference was found in age, tumor type, nuclear grade, lymphovascular invasion (LVI), multifocality, method of SLN detection and size of positive SLN metastasis
Summary
Sentinel lymph node biopsy (SLNB) has taken the place of axillary lymph node dissection (ALND) in early stage breast carcinoma and its benefits in terms of morbidity have been well established [1]. For breast cancer patients with sentinel lymph node (SLN) metastases, the benefit of ALND on survival is debated. The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial showed that women with T1 and T2 tumors who undergo lumpectomy derive little additional benefit from ALND since any residual disease in the level I and II nodes appear to be effectively eradicated by postoperative irradiation and chemotherapy [2]. 40% to 60% of patients have no disease in axillary lymph nodes other than the SLN itself and this means these patients undergo unnecessary ALND [4±6]. Our goal is to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stanford Online Calculator (SOC) for predicting non-sentinel lymph node (NSLN) metastasis in Chinese patients, and develop a new model for better prediction of NSLN metastasis
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
