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Abstract
BackgroundPrediction of axillary lymph node (ALN) status preoperatively is critical in the management of breast cancer patients. This study aims to develop a new set of nomograms to accurately predict ALN status.MethodsWe searched the National Cancer Database to identify eligible female breast cancer patients with profiles containing critical information. Patients diagnosed in 2010–2011 and 2012–2013 were designated the training (n = 99,618) and validation (n = 101,834) cohorts, respectively. We used binary logistic regression to investigate risk factors for ALN status and to develop a new set of nomograms to determine the probability of having any positive ALNs and N2–3 disease. We used ROC analysis and calibration plots to assess the discriminative ability and accuracy of the nomograms, respectively.ResultsIn the training cohort, we identified age, quadrant of the tumor, tumor size, histology, ER, PR, HER2, tumor grade and lymphovascular invasion as significant predictors of ALNs status. Nomogram-A was developed to predict the probability of having any positive ALNs (P_any) in the full population with a C-index of 0.788 and 0.786 in the training and validation cohorts, respectively. In patients with positive ALNs, Nomogram-B was developed to predict the conditional probability of having N2–3 disease (P_con) with a C-index of 0.680 and 0.677 in the training and validation cohorts, respectively. The absolute probability of having N2–3 disease can be estimated by P_any*P_con. Both of the nomograms were well-calibrated.ConclusionsWe developed a set of nomograms to predict the ALN status in breast cancer patients.
Highlights
Prediction of axillary lymph node (ALN) status preoperatively is critical in the management of breast cancer patients
The IBCSG 23–01 trial [1] demonstrated that patients with micrometastases in sentinel lymph nodes (SLNs) can be spared from axillary lymph node dissection (ALND)
ALND does not provide any additional benefit in patients who received breast-conserving surgery (BCS) with 1–2 positive SLNs, as demonstrated in the Z11 trial [2]
Summary
Prediction of axillary lymph node (ALN) status preoperatively is critical in the management of breast cancer patients. This study aims to develop a new set of nomograms to accurately predict ALN status. Treatment for early-stage breast cancer is focused on minimizing axillary surgery. The IBCSG 23–01 trial [1] demonstrated that patients with micrometastases in sentinel lymph nodes (SLNs) can be spared from axillary lymph node dissection (ALND). ALND does not provide any additional benefit in patients who received breast-conserving surgery (BCS) with 1–2 positive SLNs, as demonstrated in the Z11 trial [2]. Most of the reported models were designed to predict the probability of having any positive ALNs (≥ 1 positive ALNs). Chen et al BMC Cancer (2017) 17:561 of having N2–3 disease (>/=4 positive ALNs) for clinical decision making. In patients who fit the Z11 criteria and did not receive ALND, successful prediction of the axillary tumor burden may be informative for radiation oncologists in the determination of radiation fields
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