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Nomogram to predict pathologic complete response in HER2-positive breast cancer treated with neoadjuvant systemic
Takeo Fujii1,2, Takahiro Kogawa1, Jimin Wu3
1Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
Background:
Pathologic complete response (pCR) is associated with improved survival outcomes in patients with HER2-positive primary breast cancer. We developed a nomogram to predict the probability of pCR rates by using oestrogen receptor (ER) expression, progesterone receptor (PR) expression and HER2/CEP17 ratio as continuous variables.
Methods:
We retrospectively reviewed patients with stages I-III HER2-positive invasive breast cancer who had definitive surgery in 1999-2015 and received neoadjuvant systemic therapy (NST). Multivariate logistic regression models were applied to assess the effect of variables on pCR. A nomogram was built to estimate the probability of pCR. The discriminative ability was estimated by the concordance index (C-index). The accuracy was assessed graphically with a calibration curve.
Results:
A total of 793 patients were included in the analysis. Low ER expression (P<0.001), high HER2/CEP12 ratio (P=0.03), and non-inflammatory breast cancer subtype (P=0.003) were associated with increased pCR rates. Regimens containing trastuzumab or trastuzumab and pertuzumab were associated with higher pCR rates than cytotoxic agents alone (P<0.001 and P<0.001, respectively). The C-index was 0.69. The calibration curve showed good agreement.
Conclusions:
Our nomogram predicted the pCR rate after NST among patients with HER2-positive primary breast cancer using clinicopathologic factors.
