Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer
Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer
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DOI：
10.1200/jco.2005.01.2898
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发表时间：
2005-11-20
影响因子：
45.3
通讯作者：
Hortobagyi, GN
中科院分区：
文献类型：
--
作者：
Rouzier, R;Pusztai, L;Hortobagyi, GN
目的将术前化疗(PC)后的病理完全缓解(PCR)和无远处转移生存期(DMFS)相关的临床变量组合成一个预测图。该图在安德森癌症中心接受治疗的两个独立队列患者身上进行了测试。第一组(n=337)接受蒽环类药物；第二组(n=237)接受紫杉醇和蒽环素PC的联合治疗。结果根据临床分期、雌激素受体状态、组织学分级和术前化疗周期数建立的PCR诺模图在训练集和蒽环类药物治疗验证集上具有良好的区分性和校正性(一致性指数分别为0.77、0.79)。在紫杉醇加蒽环素组中，当预测的PCR率低于14%时，观察率为7.5%；当预测率=38%时，实际率为85%。对于14%至38%的预测率，每周一次的观察率为50%，三周一次的紫杉醇的观察率为27%。这表明，紫杉醇的优化方案对中度化疗敏感的患者益处最大。即使在纳入紫杉醇后，不太可能实现对蒽系的聚合酶链式反应的患者仍然处于低概率的聚合酶链式反应。DMFS的诺模图在验证集内的一致性指数为0.72，优于其他预测工具(P=.02)。结论我们的诺模图可以准确地预测PCR值，并可作为将未来的分子标记纳入临床预测模型的基础。
Purpose To combine clinical variables associated with pathologic complete response (pCR) and distant metastasis-free survival (DMFS) after preoperative chemotherapy (PC) into a prediction nomogram.Patients and Methods Data from 496 patients treated with anthracycline PC at the Institut Gustave Roussy were used to develop and calibrate a nomogram for pCR based on multivariate logistic regression. This nomogram was tested on two independent cohorts of patients treated at the M.D. Anderson Cancer Center. The first cohort (n = 337) received anthracycline; the second cohort (n = 237) received a combination of paclitaxel and anthracycline PC. A separate nomogram to predict DMFS was developed using Cox proportional hazards regression model.Results The pCR nomogram based on clinical stage, estrogen receptor status, histologic grade, and number of preoperative chemotherapy cycles had good discrimination and calibration in the training and the anthracycline-treated validation sets (concordance indices, 0.77, 0.79). In the paclitaxel plus anthracycline group, when the predicted pCR rate was less than 14%, the observed rate was 7.5%; for a predicted rate of >= 38%, the actual rate was 85%. For a predicted rate between 14% to 38%, the observed rates were 50% with weekly and 27% with 3-weekly paclitaxel. This indicates that patients with intermediate chemotherapy sensitivity benefit the most from the optimized schedule of paclitaxel. Patients unlikely to achieve pCR to anthracylines remain at low probability for pCR, even after inclusion of paclitaxel. The nomogram for DMFS had a concordance index of 0.72 in the validation set and outperformed other prediction tools (P = .02).Conclusion Our nomograms predict pCR accurately and can serve as a basis to integrate future molecular markers into a clinical prediction model.