Abstract
BackgroundMetaplastic breast cancer (MBC) is a rare subtype of breast cancer, and generally associated with poor outcomes. Lymph nodes metastasis (LNM) is confirmed as a critical independent prognostic factor and determine the optimal treatment strategies in MBC patients. We aimed to develop and validate a nomogram to predict the possibility of preoperative regional LNM in MBC patients.MethodsMBC patients diagnosed between 1990 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database were included and stochastically divided into a training set and validation set at a ratio of 7:3. The risk variables of regional LNM in the training set were determined by univariate and multivariate logistic regression analyses. And then we integrated those risk factors to construct the nomogram. The prediction nomogram was further verified in the verification set. The discrimination, calibration and clinical utility of the nomogram were evaluated by the area under the receiver operating characteristic (ROC) curve (AUC), calibration plots and decision curve analysis (DCA), respectively.ResultsA total of 2205 female MBC patients were included in the study. Among the 2205 patients, 24.8% (546/2205) had positive regional lymph nodes. The nomogram for predicting the risk of regional LNM contained predictors of grade, estrogen receptor (ER) status and tumor size, with AUC of 0.683 (95% confidence interval (CI): 0.653–0.713) and 0.667 (95% CI: 0.621–0.712) in the training and validation sets, respectively. Calibration plots showed perfect agreement between actual and predicted regional LNM risks. At the same time, DCA of the nomogram demonstrated good clinical utilities.ConclusionsThe nomogram established in this study showed excellent prediction ability, and could be used to preoperatively estimate the regional LNM risk in MBC.
Highlights
Metaplastic breast cancer (MBC) is a rare subtype of breast cancer, and generally associated with poor outcomes
MBC is associated with poor prognosis, and lymph nodes metastasis (LNM) is an important prognostic determinant for patients with BC
Most of the tumors lacked estrogen receptor (ER), progesterone receptor (PR), and HER2 expression. 24.8% (546/2205) of patients were confirmed to regional Lymph nodes metastasis (LNM)
Summary
Metaplastic breast cancer (MBC) is a rare subtype of breast cancer, and generally associated with poor outcomes. Lymph nodes metastasis (LNM) is confirmed as a critical independent prognostic factor and determine the optimal treatment strategies in MBC patients. MBC is associated with poor prognosis, and lymph nodes metastasis (LNM) is an important prognostic determinant for patients with BC. Preoperative evaluation of regional LNM is critical for determining the optimal treatment strategies for MBC patients. Neoadjuvant systemic therapy (NAST) has many potential advantages, including: downstaging the breast cancer and axilla, improving prognostication based on response and the chances of breast-conserving surgery. It is increasingly used in patients with clinically nodepositive BC [6]. Modified radical mastectomy with axillary lymph node dissection (ALND) remains one of the most effective surgical methods for patients with local advanced BC without distant metastasis
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