Abstract
BackgroundPrevious research results on the predictive factors of neoadjuvant chemotherapy (NCT) efficacy in breast cancer are inconsistent, suggesting that the ability of a single factor to predict efficacy is insufficient. Combining multiple potential efficacy-related factors to build a model may improve the accuracy of prediction. This study intends to explore the clinical and biological factors in breast cancer patients receiving NCT and to establish a nomogram that can predict the pathologic complete response (pCR) rate of NCT.MethodsWe selected 165 breast cancer patients receiving NCT from July 2017 to May 2019. Using pretreatment biopsy materials, immunohistochemical studies to assess estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression. The correlation between biological markers and pCR was analyzed. These predictors were used to develop a binary logistic regression model with cross-validation and to show the established predictive model with a nomogram.ResultsThe nomogram for pCR based on lymphovascular invasion, anemia (hemoglobin≤120 g/L), ER, Ki67 expression levels and NCT regimen had good discrimination performance (area under the curve [AUC], 0.758; 95% confidence interval [CI], 0.675–0.841) and calibration coordination. According to the Hosmer-Lemeshow test, the calibration chart showed satisfactory agreement between the predicted and observed probabilities. The final prediction accuracy of cross-validation was 76%.ConclusionsWe developed a nomogram based on multiple clinical and biological covariations that can provide an early prediction of NCT response and can help to quickly assess the individual benefits of NCT.
Highlights
Previous research results on the predictive factors of neoadjuvant chemotherapy (NCT) efficacy in breast cancer are inconsistent, suggesting that the ability of a single factor to predict efficacy is insufficient
The chemotherapy regimens consisted of docetaxel + epirubicin + cyclophosphamide (TEC) and docetaxel + carboplatin + trastuzumab (TCbH) every 3 weeks before surgery [11]
Based on the 8th TNM staging system recommended by the AJCC, among 165 patients, before NCT, 11.5% (19 patients) were classified with cT1, 74.5% (123 patients) were classified with cT2, 13.9% (23 patients) were classified with cT3, 31.5% (52 patients) were classified with cN0, and 68.5% (113 patients) were classified with cN1– 2
Summary
Previous research results on the predictive factors of neoadjuvant chemotherapy (NCT) efficacy in breast cancer are inconsistent, suggesting that the ability of a single factor to predict efficacy is insufficient. This study intends to explore the clinical and biological factors in breast cancer patients receiving NCT and to establish a nomogram that can predict the pathologic complete response (pCR) rate of NCT. Pu et al BMC Cancer (2020) 20:1120 patients who achieve pCR after NCT exhibit improved survival [6, 9]. Some baseline clinicopathological features can predict the curative effect of NCT for breast cancer and further reflect the long-term outcomes of patient treatment. These factors should help us select the patients who will benefit most from treatment and recommend a tailored approach when choosing the initial treatment to give patients the best response to treatment and subsequent overall survival [9, 10]
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