Nomogram Predicting Axillary Lymph Node Dissection Omission After Neoadjuvant Chemotherapy for Node-positive Breast...

Area of Science:

• Oncology
• Breast Cancer Research
• Clinical Prediction Models

Background:

• Accurate prediction of nodal pathological complete response (ypN0) is crucial for guiding axillary treatment in clinically node-positive breast cancer patients undergoing neoadjuvant chemotherapy (NAC).
• Current prediction methods may not fully capture all relevant factors, leading to potential overtreatment or undertreatment.

Purpose of the Study:

• To develop and validate an accurate predictive model for ypN0 in patients with clinically node-positive breast cancer post-NAC.
• To identify key independent predictors of ypN0 to enhance treatment individualization.

Main Methods:

• A cohort of 128 patients with clinically node-positive breast cancer who received NAC followed by axillary lymph node dissection was analyzed.
• A nomogram was developed incorporating estrogen receptor status, clinical tumor response (ycT0), and clinical nodal response (ycN0) as predictive factors.

Main Results:

• The developed nomogram achieved a high negative predictive value (NPV) of 92.9% and a low false-negative rate (FNR) of 4.5% for predicting ypN0.
• This represents a significant improvement over prediction using clinical nodal response alone, with an approximate 15% increase in NPV.
• Estrogen receptor status, ycT0, and ycN0 were identified as independent predictors of ypN0.

Conclusions:

• Estrogen receptor negativity, ycT0, and ycN0 are significant independent predictors of ypN0 following NAC in node-positive breast cancer.
• The developed nomogram demonstrates superior accuracy in predicting ypN0, potentially enabling more individualized axillary treatment strategies and improving patient outcomes.