Abstract
BackgroundNeoadjuvant chemotherapy (NACT) is considered a standard treatment strategy for locally advanced triple negative breast cancer (TNBC). TNBC patients who achieve a pathologic complete response (pCR) are predicted to have a better prognosis while unfavorable chemo-sensitivity is still associated with a higher risk of disease relapse. The objective of this study was to construct a nomogram to predict disease-free survival (DFS) for TNBC patients following NACT.MethodsA total of 165 TNBC patients who underwent standard NACT and surgery were retrospectively reviewed, and data on their clinicopathological factors before and after NACT were collected. Independent prognostic factors for DFS were identified by Cox regression based on lower Akaike information criteria (AIC) and Bayesian information criterion (BIC). A nomogram to predict the 2-year and 5-year DFS following NACT for TNBC was constructed based on training cohort (n = 132) and validated by a validation cohort (n = 33).ResultsEither limited or full pCR (breast-only pCR, node-only pCR, or both-pCR) indicated significantly improved DFS and overall survival (OS) (p < 0.001). Lager residual tumor size (hazard ratio [HR] 1.175, p = 0.011) and the presence of lymphatic vessel invasion (LVI) (HR 3.168, p = 0.001) were identified as independent predictors of disease relapse in the training cohort. Five variables, including age, primary tumor size, histological grade, residual tumor size, and LVI were used to establish the nomogram. The C-index of the nomogram was 0.815, and calibration curves showed an acceptable consistency between the actual and nomogram-predicted 2-year and 5-year DFS. The proposed nomogram demonstrated superior predictive performance compared with Residual Cancer Burden (RCB) classification and the 8th American Joint Committee on Cancer Post Neoadjuvant Therapy Classification (AJCC ypTNM) staging system (area under the curve [AUC] for 2-year DFS: 0.870 vs. 0.758 vs. 0.711, respectively; AUC for 5-year DFS: 0.794 vs. 0.731 vs. 0.702, respectively) in the validation cohort.ConclusionsThe nomogram proposed in our study enabled to quantify the risk of disease relapse and demonstrated superior predictive performance than a survival predict instrument. It was an easy-to-use tool for clinicians to guide individualized surveillance of TNBC patients following standard NACT.
Highlights
For patients with triple negative breast cancer (TNBC), characterized by lack of expression of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor-2 (HER-2) amplification, chemotherapy remains the chief systemic treatment option because specific endocrine and molecular targets are unavailable [1]
Despite the aggressive clinical behavior of TNBC, approximately 30-40% of patients can achieve pathologic complete response after Neoadjuvant chemotherapy (NACT) [2]. pCR is a strong surrogate of better outcome for TNBC [3], and for patients with residual invasive disease after standard NACT based on a combination of anthracycline and taxane, adjuvant capecitabine therapy would be recommended to improve prognosis [4]
The Residual Cancer Burden (RCB) system calculates a score based on the primary tumor bed area containing residual tumor, overall cancer cellularity, percentage of cancer that is considered in situ disease, number of positive lymph nodes, and the diameter of the largest metastasis [6]
Summary
For patients with triple negative breast cancer (TNBC), characterized by lack of expression of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor-2 (HER-2) amplification, chemotherapy remains the chief systemic treatment option because specific endocrine and molecular targets are unavailable [1]. Node, and metastasis are included, both the RCB and AJCC ypTNM systems are preferred for pathologic evaluation of post-neoadjuvant specimens and are commonly used as instruments to predict survival after NACT [8]. There are still limitations, such as age, histological grade, lymphatic vessel invasion (LVI) and post neoadjuvant therapy that have not been taken into account for prognostic prediction This indicates that currently no ideal multivariable predictor exists to estimate the recurrence probability after NACT. Neoadjuvant chemotherapy (NACT) is considered a standard treatment strategy for locally advanced triple negative breast cancer (TNBC). TNBC patients who achieve a pathologic complete response (pCR) are predicted to have a better prognosis while unfavorable chemo-sensitivity is still associated with a higher risk of disease relapse. The objective of this study was to construct a nomogram to predict disease-free survival (DFS) for TNBC patients following NACT
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