Comparison of Models to Predict Nonsentinel Lymph Node Status in Breast Cancer Patients With Metastatic Sentinel Lymph Nodes: A Prospective Multicenter Study
Comparison of Models to Predict Nonsentinel Lymph Node Status in Breast Cancer Patients With Metastatic Sentinel Lymph Nodes: A Prospective Multicenter Study
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DOI：
10.1200/jco.2008.19.7418
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发表时间：
2009-06-10
影响因子：
45.3
通讯作者：
Rouzier, Roman
中科院分区：
文献类型：
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作者：
Coutant, Charles;Olivier, Camille;Rouzier, Roman
目的已建立了几种模型来预测乳腺癌前哨淋巴结(SN)转移患者的非前哨淋巴结(Non-SN)状态。我们调查的目的是在一项前瞻性的多中心研究中比较可用的模型。患者和方法在561名接受腋窝淋巴结清扫的SN阳性患者中，我们评估了根据9个模型计算的受试者工作特征曲线(AUC)下的面积、校准、假阴性率(FN)和低风险非SN患者的数量。结果147例患者中，至少有一例(26.2%)发生转移。九款机型中只有两款的AUC大于0.75。三个模型得到了很好的校准。有两个模型的FN比率低于5%。三个模型能够将超过三分之一的患者分配到低风险组。总体而言，纪念斯隆-凯特琳癌症中心诺模图和Tenon评分对所有患者都优于其他方法，包括仅有SN微转移或ITC的患者亚组。结论我们的研究表明，所有模型的表现并不相同，特别是对于仅有微转移或在SN中有ITC的患者亚组。我们指出了可用的评估方法来评估他们的表现，并为临床实践提供指导。
PurposeSeveral models have been developed to predict nonsentinel lymph node (non-SN) status in patients with breast cancer with sentinel lymph node (SN) metastasis. The purpose of our investigation was to compare available models in a prospective, multicenter study.Patients and MethodsIn a cohort of 561 positive-SN patients who underwent axillary lymph node dissection, we evaluated the areas under the receiver operating characteristic curves (AUCs), calibration, rates of false negatives (FN), and number of patients in the group at low risk for non-SN calculated from nine models. We also evaluated these parameters in the subgroup of patients with micrometastasis or isolated tumor cells (ITC) in the SN.ResultsAt least one non-SN was metastatic in 147 patients (26.2%). Only two of nine models had an AUC greater than 0.75. Three models were well calibrated. Two models yielded an FN rate less than 5%. Three models were able to assign more than a third of patients in the low-risk group. Overall, the Memorial Sloan-Kettering Cancer Center nomogram and Tenon score outperform other methods for all patients, including the subgroup of patients with only SN micrometastases or ITC.ConclusionOur study suggests that all models do not perform equally, especially for the subgroup of patients with only micrometastasis or ITC in the SN. We point out available evaluation methods to assess their performance and provide guidance for clinical practice.