by Fabio Corsi, Sara Albasini, Luca Sorrentino, Giulia
Armatura, Claudia Carolla, Corrado Chiappa, Francesca Combi, Annalisa Curcio,
Angelica Della Valle, Guglielmo Ferrari, Maria Luisa Gasparri, Oreste
Gentilini, Matteo Ghilli, Chiara Listorti, Stefano Mancini, Peter Marinello,
Francesco Meani, Simone Mele, Anna Pertusati, Manuela Roncella, Francesca
Rovera, Adele Sgarella, Giovanni Tazzioli, Daniela Tognali, Secondo Folli
The Breast: VOLUME 60, P131-137, DECEMBER
01, 2021
Background
Type of axillary surgery in breast cancer (BC) patients who
convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is
still debated. The aim of the present study was to develop and validate a
preoperative predictive nomogram to select those patients with a low risk of
residual axillary disease after NAC, in whom axillary surgery could be
minimized.
Patients and methods
1950 clinically node-positive BC patients from 11 Breast
Units, treated by NAC and subsequent surgery, were included from 2005 to 2020.
Patients were divided in two groups: those who achieved nodal pCR vs. those
with residual nodal disease after NAC. The cohort was divided into training and
validation set with a geographic separation criterion. The outcome was to
identify independent predictors of axillary pathologic complete response (pCR).
Results
Independent predictive factors associated to nodal pCR were
axillary clinical complete response (cCR) after NAC (OR 3.11,
p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or
ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89,
p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001),
Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2
(OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The
nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI
0.75–0.80). After external validation the accuracy of the nomogram was
confirmed.
Conclusion
The accuracy makes this freely-available, nomogram-based
online tool useful to predict nodal pCR after NAC, translating the concept of
tailored axillary surgery also in this setting of patients.
