Nomogram for Predicting Neoadjuvant Chemotherapy Response in Breast Cancer Using MRI-based Intratumoral Heterogeneity
Yao Huang1,2, Xiaoxia Wang2, Ying Cao1,2
1School of Medicine, Chongqing University, Chongqing, China.
Radiology
|April 15, 2025
Summary
This study developed a novel nomogram using pretreatment MRI to predict breast cancer treatment response and recurrence. The tool quantifies intratumoral heterogeneity (ITH) for better patient outcomes.
Area of Science:
- Oncology
- Radiology
- Genomics
Background:
- Intratumoral heterogeneity (ITH) in breast cancer is a key driver of treatment failure and disease relapse.
- Current noninvasive methods for quantifying ITH are limited, hindering effective treatment planning.
Purpose of the Study:
- To develop a quantitative measure of ITH from pretreatment MRI scans in breast cancer patients.
- To create a nomogram predicting pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) and recurrence-free survival (RFS).
- To investigate the association between nomogram-derived scores and underlying biologic pathways.
Main Methods:
- Retrospective analysis of 1448 breast cancer patients undergoing NAC across nine centers.
- Calculation of ITH scores by clustering tumor regions and analyzing pixel distribution on MRI.
- Development of a nomogram using multivariable logistic regression, validated externally.
- Correlation analysis with RFS and genomic data to explore pathway associations.
Main Results:
- The ITH score independently predicted pCR to NAC (OR, 0.12; P < .001).
- The nomogram demonstrated strong predictive performance in external validation sets (AUCs 0.79-0.82).
- Lower nomogram scores correlated with poorer RFS (HR, 4.04; P < .001) and were linked to upregulated tumor proliferation pathways.
Conclusions:
- A nomogram integrating ITH score and clinicopathologic variables effectively predicts pCR to NAC and RFS in breast cancer.
- This approach offers a promising noninvasive tool for assessing treatment response and prognosis.
- Findings highlight the role of ITH in treatment failure and suggest potential therapeutic targets related to proliferation pathways.
