Abstract
BackgroundIt is reported that appropriately 50% of early breast cancer patients with 1–2 positive sentinel lymph node (SLN) micro-metastases could not benefit from axillary lymph node dissection (ALND) or breast-conserving surgery with whole breast irradiation. However, whether patients with 1–2 positive SLN macro-metastases could benefit from ALND remains unknown. The aim of our study was to develop and validate nomograms for assessing axillary non-SLN metastases in patients with 1–2 positive SLN macro-metastases, using their pathological features alone or in combination with STMs.MethodsWe retrospectively reviewed pathological features and STMs of 1150 early breast cancer patients from two independent cohorts. Best subset regression was used for feature selection and signature building. The risk score of axillary non-SLN metastases was calculated for each patient as a linear combination of selected predictors that were weighted by their respective coefficients.ResultsThe pathology-based nomogram possessed a strong discrimination ability for axillary non-SLN metastases, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.727 (95% CI: 0.682–0.771) in the primary cohort and 0.722 (95% CI: 0.653–0.792) in the validation cohort. The addition of CA 15–3 and CEA can significantly improve the performance of pathology-based nomogram in the primary cohort (AUC: 0.773 (0.732–0.815) vs. 0.727 (0.682–0.771), P < 0.001) and validation cohort (AUC: (0.777 (0.713–0.840) vs. 0.722 (0.653–0.792), P < 0.001). Decision curve analysis demonstrated that the nomograms were clinically useful.ConclusionThe nomograms based on pathological features can be used to identify axillary non-SLN metastases in breast cancer patients with 1–2 positive SLN. In addition, the combination of STMs and pathological features can identify patients with patients with axillary non-SLN metastases more accurately than pathological characteristics alone.
Highlights
It is reported that appropriately 50% of early breast cancer patients with 1–2 positive sentinel lymph node (SLN) micro-metastases could not benefit from axillary lymph node dissection (ALND) or breast-conserving surgery with whole breast irradiation
Using the regression coefficients of multivariate logistic regression models to weight each feature in our models, we developed a risk score formula to predict axillary non-SLN metastases: risk score = − 1.298 + 1.014 + 0.664 (if high grade tumor (G2/G3)) + 0.862 + 1.342 + (0.979, if number of negative SLN = 1; 0.729, if number of negative SLN = 0)
The results demonstrated that the addition of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 15–3 could significantly improve the performance of pathology-based model in the primary cohort (AUC: 0.773 (0.732–0.815) vs. 0.727 (0.682–0.771), P < 0.001) and validation cohort (AUC: (0.777 (0.713–0.840) vs. 0.722 (0.653–0.792), P < 0.001)
Summary
It is reported that appropriately 50% of early breast cancer patients with 1–2 positive sentinel lymph node (SLN) micro-metastases could not benefit from axillary lymph node dissection (ALND) or breast-conserving surgery with whole breast irradiation. Whether patients with 1–2 positive SLN macro-metastases could benefit from ALND remains unknown. The optimal management of SLN positive patients remains controversial, since no more than half of patients have axillary nonSLN metastases when axillary lymph node dissection (ALND) is performed [3, 4]. In order to reduce unnecessary postoperative complications followed by ALND, breast-conserving surgery with whole breast irradiation has been recommended in patients with 1–2 positive SLN micro-metastases [5, 6]. Whether patients with 1–2 positive SLN macro-metastases could benefit from breast conserving therapy and whole-breast radiotherapy remains controversial. There is an urgent need to develop a nomogram for predicting the risk of non-SLN metastases in patients with 1–2 positive SLN macro-metastases
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