Development and External Validation of a Nomogram to Predict Four or More Positive Nodes in Breast Cancer Patients with One to Three Positive Sentinel Lymph Nodes

Overview

Journal Breast

Publisher Elsevier

Specialties Endocrinology
Oncology

Date 2020 Aug 22

PMID 32823167

Citations 8

Authors

Zhuanbo Yang

Xiaowen Lan

Zhou Huang

Yong Yang

Yu Tang

Hao Jing

Jianyang Wang

Jianghu Zhang

Xiang Wang

Jidong Gao

Jing Wang

Lixue Xuan

Yi Fang

Jianming Ying

Yexiong Li

Xiaobo Huang

Shulian Wang

Affiliations

Soon will be listed here.

Abstract

Objective: To develop a nomogram for predicting the possibility of four or more positive nodes in breast cancer patients with 1-3 positive sentinel lymph nodes (SLN).

Materials And Methods: Retrospective analysis of data of patients from two institutions was conducted. The inclusion criteria were: invasive breast cancer; clinically node negative; received lumpectomy or mastectomy plus SLN biopsy followed by axillary lymph node dissection (ALND); and pathologically confirmed T1-2 tumor, with 1-3 positive SLNs. Patients from one institution formed the training group and patients from the other the validation group. Univariate and multivariate analyses were performed to identify the predictors of four or more positive nodes. These predictors were used to build the nomogram. The area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of the model.

Results: Of the 1480 patients (966 patients in the training group, 514 in the validation group), 306 (20.7%) had four or more positive nodes. Multivariate stepwise logistic regression showed number of positive (p < .001) and negative SLN (p < .001), extracapsular extension (p < .001), pT stage (p = .016), and tumor location in outer upper quadrant (p = .031) to be independent predictors of four or more positive nodes. The nomogram was built using these five factors. The AUC was 0.845 in the training group and 0.804 in the validation group.

Conclusion: The proposed nomogram appears to accurately estimate the likelihood of four or more positive nodes and could help radiation oncologists to decide on use of regional nodal irradiation (RNI) for breast cancer patients with 1-3 positive nodes but no ALND.

Citing Articles

Nomograms for metastasis of non-sentinel lymph nodes or more than three lymph nodes in patients with one or two positive sentinel lymph nodes.

Wang X, Bi Z, Zhang J, Wang Y Front Oncol. 2024; 14:1413936.

PMID: 38835388 PMC: 11148251. DOI: 10.3389/fonc.2024.1413936.

Advances in regional nodal management of early-stage breast cancer.

Bi Z, Wang Y Chin J Cancer Res. 2024; 36(2):215-225.

PMID: 38751438 PMC: 11090791. DOI: 10.21147/j.issn.1000-9604.2024.02.08.

A multi-dimensional nomogram to predict non-sentinel lymph node metastases in T1-2HR+ breast cancer.

Xiang K, Chen J, Min Y, Chen H, Yang J, Hu D Front Endocrinol (Lausanne). 2023; 14:1121394.

PMID: 37476497 PMC: 10354643. DOI: 10.3389/fendo.2023.1121394.

Optimization of regional nodal irradiation in the era of sentinel lymph node biopsy.

Bi Z, Wang X, Qiu P, Chen P, Wang Y Cancer Biol Med. 2023; 20(2).

PMID: 36861446 PMC: 9978891. DOI: 10.20892/j.issn.2095-3941.2022.0625.

Development and validation of a pre- and intra-operative scoring system that distinguishes between non-advanced and advanced axillary lymph node metastasis in breast cancer with positive sentinel lymph nodes: a retrospective study.

Murata T, Watase C, Shiino S, Kurita A, Ogawa A, Jimbo K World J Surg Oncol. 2022; 20(1):314.

PMID: 36171615 PMC: 9516796. DOI: 10.1186/s12957-022-02779-9.

References

Giuliano A, Ballman K, McCall L, Beitsch P, Brennan M, Kelemen P . Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017; 318(10):918-926. PMC: 5672806. DOI: 10.1001/jama.2017.11470. View

Kim I, Ryu J, Kim J, Choi H, Lee S, Yu J . Development of a Nomogram to Predict N2 or N3 Stage in T1-2 Invasive Breast Cancer Patients with No Palpable Lymphadenopathy. J Breast Cancer. 2017; 20(3):270-278. PMC: 5620442. DOI: 10.4048/jbc.2017.20.3.270. View

Belkacemi Y, Kaidar-Person O, Poortmans P, Ozsahin M, Valli M, Russell N . Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey. Ann Oncol. 2014; 26(3):529-35. DOI: 10.1093/annonc/mdu561. View

Tendulkar R, Rehman S, Shukla M, Reddy C, Moore H, Budd G . Impact of postmastectomy radiation on locoregional recurrence in breast cancer patients with 1-3 positive lymph nodes treated with modern systemic therapy. Int J Radiat Oncol Biol Phys. 2012; 83(5):e577-81. DOI: 10.1016/j.ijrobp.2012.01.076. View

Lyman G, Temin S, Edge S, Newman L, Turner R, Weaver D . Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014; 32(13):1365-83. DOI: 10.1200/JCO.2013.54.1177. View

Xie X, Tan W, Chen B, Huang X, Peng C, Yan S . Preoperative prediction nomogram based on primary tumor miRNAs signature and clinical-related features for axillary lymph node metastasis in early-stage invasive breast cancer. Int J Cancer. 2017; 142(9):1901-1910. DOI: 10.1002/ijc.31208. View

Chagpar A, Scoggins C, Martin 2nd R, Cook E, McCurry T, Mizuguchi N . Predicting patients at low probability of requiring postmastectomy radiation therapy. Ann Surg Oncol. 2006; 14(2):670-7. DOI: 10.1245/s10434-006-9107-8. View

Whelan T, Olivotto I, Parulekar W, Ackerman I, Chua B, Nabid A . Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 2015; 373(4):307-16. PMC: 4556358. DOI: 10.1056/NEJMoa1415340. View

McBride A, Allen P, Woodward W, Kim M, Kuerer H, Drinka E . Locoregional recurrence risk for patients with T1,2 breast cancer with 1-3 positive lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys. 2014; 89(2):392-8. DOI: 10.1016/j.ijrobp.2014.02.013. View

10.

Zhang J, Li X, Huang R, Feng W, Kong Y, Xu F . A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study. Oncotarget. 2016; 8(21):35311-35325. PMC: 5471057. DOI: 10.18632/oncotarget.13330. View

11.

Azghadi S, Daly M, Mayadev J . Practice Patterns of Radiation Field Design for Sentinel Lymph Node-Positive Early-Stage Breast Cancer. Clin Breast Cancer. 2016; 16(5):410-417.e3. DOI: 10.1016/j.clbc.2016.05.009. View

12.

Collins G, Reitsma J, Altman D, Moons K . Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. 2015; 350:g7594. DOI: 10.1136/bmj.g7594. View

13.

Savolt A, Peley G, Polgar C, Udvarhelyi N, Rubovszky G, Kovacs E . Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla - Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: A randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017; 43(4):672-679. DOI: 10.1016/j.ejso.2016.12.011. View

14.

Lyman G, Somerfield M, Giuliano A . Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: 2016 American Society of Clinical Oncology Clinical Practice Guideline Update Summary. J Oncol Pract. 2017; 13(3):196-198. DOI: 10.1200/JOP.2016.019992. View

15.

Overgaard M, Jensen M, Overgaard J, Hansen P, Rose C, Andersson M . Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999; 353(9165):1641-8. DOI: 10.1016/S0140-6736(98)09201-0. View

16.

Galimberti V, Cole B, Viale G, Veronesi P, Vicini E, Intra M . Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018; 19(10):1385-1393. DOI: 10.1016/S1470-2045(18)30380-2. View

17.

Raber B, Lin H, Shen Y, Shaitelman S, Bedrosian I . Trends in Regional Nodal Management of Breast Cancer Patients with Low Nodal Burden. Ann Surg Oncol. 2019; 26(13):4346-4354. DOI: 10.1245/s10434-019-07901-y. View

18.

Donker M, van Tienhoven G, Straver M, Meijnen P, van de Velde C, Mansel R . Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014; 15(12):1303-10. PMC: 4291166. DOI: 10.1016/S1470-2045(14)70460-7. View

19.

Shimazu K, Sato N, Ogiya A, Sota Y, Yotsumoto D, Ishikawa T . Intraoperative Nomograms, Based on One-Step Nucleic Acid Amplification, for Prediction of Non-sentinel Node Metastasis and Four or More Axillary Node Metastases in Breast Cancer Patients with Sentinel Node Metastasis. Ann Surg Oncol. 2018; 25(9):2603-2611. PMC: 6097722. DOI: 10.1245/s10434-018-6633-0. View

20.

Ragaz J, Jackson S, Le N, Plenderleith I, Spinelli J, Basco V . Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997; 337(14):956-62. DOI: 10.1056/NEJM199710023371402. View