Predicting Pathological Complete Response After Neoadjuvant Chemotherapy in Advanced Breast Cancer by Ultrasound and Clinicopathological Features Using a Nomogram.

Hao Cui,Fuhui Peng,Peng Han,Hanqing Kong,Dantong Zhao,Ying Wang,Lei Zhang,Xudong Zhang,Panting Wang,Jiawei Tian,Wei Fan,Nana Hu,Xiaoxuan Zuo

doi:10.3389/fonc.2021.718531

Abstract

Background and AimsPrediction of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer is critical for surgical planning and evaluation of NAC efficacy. The purpose of this project was to assess the efficiency of a novel nomogram based on ultrasound and clinicopathological features for predicting pCR after NAC.MethodsThis retrospective study included 282 patients with advanced breast cancer treated with NAC from two centers. Patients received breast ultrasound before NAC and after two cycles of NAC; and the ultrasound, clinicopathological features and feature changes after two cycles of NAC were recorded. A multivariate logistic regression model was combined with bootstrapping screened for informative features associated with pCR. Then, we constructed two nomograms: an initial-baseline nomogram and a two-cycle response nomogram. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were analyzed. The C-index was used to evaluate predictive accuracy.ResultsSixty (60/282, 21.28%) patients achieved pCR. Triple-negative breast cancer (TNBC) and HER2-amplified types were more likely to obtain pCR. Size shrinkage, posterior acoustic pattern, and elasticity score were identified as independent factors by multivariate logistic regression. In the validation cohort, the two-cycle response nomogram showed better discrimination than the initial-baseline nomogram, with the C-index reaching 0.79. The sensitivity, specificity, and NPV of the two-cycle response nomogram were 0.77, 0.77, and 0.92, respectively.ConclusionThe two-cycle response nomogram exhibited satisfactory efficiency, which means that the nomogram was a reliable method to predict pCR after NAC. Size shrinkage after two cycles of NAC was an important in dependent factor in predicting pCR.

Highlights

With approximately 279,000 new cases diagnosed each year in China, breast cancer is a serious concern among the female population [1]
Based on the tumor response of effective cases after two cycles, which may be the most obvious [20], we developed another nomogram incorporating the changes in the ultrasound features to indicate the initial response to Neoadjuvant chemotherapy (NAC)
Our results indicated that informative ultrasound features, including posterior acoustic and elasticity scores, were associated with pathological complete response (pCR)

Summary

Introduction

With approximately 279,000 new cases diagnosed each year in China, breast cancer is a serious concern among the female population [1]. Results from the National Surgical Adjuvant Breast and Bowel Project B-18 trial and European Organization for Research and Treatment of Cancer Trial 10902 established the equivalency of NAC and adjuvant chemotherapy regarding disease-free and overall survival and demonstrated that NAC has the added advantage of increasing breast conservation rates with acceptable local control [5]; what is more, pathological complete response (pCR) after NAC is considered to be a better outcome [6]. Prediction of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer is critical for surgical planning and evaluation of NAC efficacy.

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Conclusion