Development and validation of nomograms for predicting axillary non-SLN metastases in breast cancer patients with 1–2 positive sentinel lymph node macro-metastases: a retrospective analysis of two independent cohorts

Abstract

Background It is reported that appropriately 50% of early breast cancer patients with 1–2 positive sentinel lymph node (SLN) micro-metastases could not benefit from axillary lymph node dissection (ALND) or breast-conserving surgery with whole breast irradiation. However, whether patients with 1–2 positive SLN macro-metastases could benefit from ALND remains unknown. The aim of our study was to develop and validate nomograms for assessing axillary non-SLN metastases in patients with 1–2 positive SLN macro-metastases, using their pathological features alone or in combination with STMs. Methods We retrospectively reviewed pathological features and STMs of 1150 early breast cancer patients from two independent cohorts. Best subset regression was used for feature selection and signature building. The risk score of axillary non-SLN metastases was calculated for each patient as a linear combination of selected predictors that were weighted by their respective coefficients. Results The pathology-based nomogram possessed a strong discrimination ability for axillary non-SLN metastases, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.727 (95% CI: 0.682–0.771) in the primary cohort and 0.722 (95% CI: 0.653–0.792) in the validation cohort. The addition of CA 15–3 and CEA can significantly improve the performance of pathology-based nomogram in the primary cohort (AUC: 0.773 (0.732–0.815) vs. 0.727 (0.682–0.771), P < 0.001) and validation cohort (AUC: (0.777 (0.713–0.840) vs. 0.722 (0.653–0.792), P < 0.001). Decision curve analysis demonstrated that the nomograms were clinically useful. Conclusion The nomograms based on pathological features can be used to identify axillary non-SLN metastases in breast cancer patients with 1–2 positive SLN. In addition, the combination of STMs and pathological features can identify patients with patients with axillary non-SLN metastases more accurately than pathological characteristics alone.

Development and validation of nomograms for predicting axillary non-SLN metastases in breast cancer patients: A retrospective analysis

“…extracapsular extension were independent risk factors for non-SLN metastasis. While some research has shown that non-SLN metastasis is associated with the number of tumor lesions in breast cancer, no association was observed in our study (8). In the MSKCC nomogram, the effect of ER status was only borderline significant (p = 0.08), but ER status was included in the MSKCC nomogram to improve the overall predictive capacity (4).…”

Non-sentinel lymph node metastases risk factors in patients with breast cancer with one or two sentinel lymph node macro-metastases

“…Duplicate studies accounted for 516 of these exclusions, whereas screening titles and abstracts resulted in another 1114 exclusions. The full texts of 125 articles were evaluated and 25 studies met the inclusion criteria [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. Fig.…”

“…China (n = 20), Turkey (n = 3), Italy (n = 1), and Japan (n = 1) were among the 25 included studies, with varying geographical locations and ethnic backgrounds. In addition, one study included two subgroup cohorts [ 21 ]. Table 1 presents the characteristics of the included studies.…”

Non-sentinel node metastasis prediction during surgery in breast cancer patients with one to three positive sentinel node(s) following neoadjuvant chemotherapy

“…Yu et al recently reported a nomogram based on the factors which included serum tumor markers such as CA 15–3 and CEA 14 . They demonstrated that the addition of CEA and CA15-3 significantly improved the discrimination ability of the nomogram compared to the nomogram without both serum markers.…”