Systematic Review of Nomograms Used for Predicting Pathological Complete Response in Early Breast Cancer

Area of Science:

• Oncology
• Clinical Research
• Biostatistics

Background:

• Pathological complete response (pCR) is a key surrogate outcome for evaluating neoadjuvant chemotherapy (NAC) efficacy.
• Nomograms predicting pCR aim to personalize NAC selection, but their validity requires critical assessment.

Purpose of the Study:

• To systematically review and critically appraise nomograms developed for predicting pCR in patients receiving NAC over the last two decades (2010-2022).

Main Methods:

• A systematic literature search was conducted across PubMed/MEDLINE, Embase, and Cochrane databases.
• Seven studies met the inclusion criteria from an initial 1120 hits.
• Analysis focused on nomogram development, validation, data sources, and patient subtypes.

Main Results:

• No meta-analysis was possible due to heterogeneity in outcome reporting and pCR definitions.
• Most nomograms originated from Asian centers using retrospective data; triple-negative breast cancer was the most studied subtype.
• Limited validation and unclear outcome measurements (e.g., DFS, OS) were noted.

Conclusions:

• Existing nomograms for predicting pCR after NAC have limited external validity and cannot be reliably extrapolated across different clinical settings.
• Significant heterogeneity and lack of standardized reporting hinder generalizability.
• Future research should focus on developing more robust and externally validated nomograms with clear outcome definitions.