Skip to main content
Top
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Research article

A nomogram for predicting pathological complete response in patients with human epidermal growth factor receptor 2 negative breast cancer

Authors: Xi Jin, Yi-Zhou Jiang, Sheng Chen, Ke-Da Yu, Ding Ma, Wei Sun, Zhi-Min Shao, Gen-Hong Di

Published in: BMC Cancer | Issue 1/2016

Login to get access

Abstract

Background

The response to neoadjuvant chemotherapy has been proven to predict long-term clinical benefits for patients. Our research is to construct a nomogram to predict pathological complete response of human epidermal growth factor receptor 2 negative breast cancer patients.

Methods

We enrolled 815 patients who received neoadjuvant chemotherapy from 2003 to 2015 and divided them into a training set and a validation set. Univariate logistic regression was performed to screen for predictors and construct the nomogram; multivariate logistic regression was performed to identify independent predictors.

Results

After performing the univariate logistic regression analysis in the training set, tumor size, hormone receptor status, regimens of neoadjuvant chemotherapy and cycles of neoadjuvant chemotherapy were the final predictors for the construction of the nomogram. The multivariate logistic regression analysis demonstrated that T4 status, hormone receptor status and receiving regimen of paclitaxel and carboplatin were independent predictors of pathological complete response. The area under the receiver operating characteristic curve of the training set and the validation set was 0.779 and 0.701, respectively.

Conclusions

We constructed and validated a nomogram to predict pathological complete response in human epidermal growth factor receptor 2 negative breast cancer patients. We also identified tumor size, hormone receptor status and paclitaxel and carboplatin regimen as independent predictors of pathological complete response.
Appendix
Available only for authorised users
Literature
1.
go back to reference DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61(6):409–18.CrossRefPubMed DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61(6):409–18.CrossRefPubMed
2.
go back to reference Generali D, Ardine M, Strina C, Milani M, Cappelletti MR, Zanotti L, Forti M, Bedussi F, Martinotti M, Amoroso V, et al. Neoadjuvant treatment approach: the Rosetta stone for breast cancer? J Natl Cancer Inst Monogr. 2015;2015(51):32–5.CrossRefPubMed Generali D, Ardine M, Strina C, Milani M, Cappelletti MR, Zanotti L, Forti M, Bedussi F, Martinotti M, Amoroso V, et al. Neoadjuvant treatment approach: the Rosetta stone for breast cancer? J Natl Cancer Inst Monogr. 2015;2015(51):32–5.CrossRefPubMed
3.
go back to reference Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.CrossRefPubMed Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.CrossRefPubMed
4.
5.
go back to reference Straver ME, Rutgers EJ, Rodenhuis S, Linn SC, Loo CE, Wesseling J, Russell NS, Oldenburg HS, Antonini N, Vrancken Peeters MT. The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy. Ann Surg Oncol. 2010;17(9):2411–8.CrossRefPubMedPubMedCentral Straver ME, Rutgers EJ, Rodenhuis S, Linn SC, Loo CE, Wesseling J, Russell NS, Oldenburg HS, Antonini N, Vrancken Peeters MT. The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy. Ann Surg Oncol. 2010;17(9):2411–8.CrossRefPubMedPubMedCentral
6.
go back to reference Harlan LC, Clegg LX, Abrams J, Stevens JL, Ballard-Barbash R. Community-based use of chemotherapy and hormonal therapy for early-stage breast cancer: 1987–2000. J Clin Oncol. 2006;24(6):872–7.CrossRefPubMed Harlan LC, Clegg LX, Abrams J, Stevens JL, Ballard-Barbash R. Community-based use of chemotherapy and hormonal therapy for early-stage breast cancer: 1987–2000. J Clin Oncol. 2006;24(6):872–7.CrossRefPubMed
7.
go back to reference Jones SE, Savin MA, Holmes FA, O’Shaughnessy JA, Blum JL, Vukelja S, McIntyre KJ, Pippen JE, Bordelon JH, Kirby R, et al. Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol. 2006;24(34):5381–7.CrossRefPubMed Jones SE, Savin MA, Holmes FA, O’Shaughnessy JA, Blum JL, Vukelja S, McIntyre KJ, Pippen JE, Bordelon JH, Kirby R, et al. Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol. 2006;24(34):5381–7.CrossRefPubMed
8.
go back to reference Silver DP, Richardson AL, Eklund AC, Wang ZC, Szallasi Z, Li Q, Juul N, Leong CO, Calogrias D, Buraimoh A, et al. Efficacy of neoadjuvant Cisplatin in triple-negative breast cancer. J Clin Oncol. 2010;28(7):1145–53.CrossRefPubMedPubMedCentral Silver DP, Richardson AL, Eklund AC, Wang ZC, Szallasi Z, Li Q, Juul N, Leong CO, Calogrias D, Buraimoh A, et al. Efficacy of neoadjuvant Cisplatin in triple-negative breast cancer. J Clin Oncol. 2010;28(7):1145–53.CrossRefPubMedPubMedCentral
9.
go back to reference von Minckwitz G, Schneeweiss A, Loibl S, Salat C, Denkert C, Rezai M, Blohmer JU, Jackisch C, Paepke S, Gerber B, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol. 2014;15(7):747–56.CrossRef von Minckwitz G, Schneeweiss A, Loibl S, Salat C, Denkert C, Rezai M, Blohmer JU, Jackisch C, Paepke S, Gerber B, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol. 2014;15(7):747–56.CrossRef
10.
11.
go back to reference Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol. 2008;26(8):1364–70.CrossRefPubMed Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol. 2008;26(8):1364–70.CrossRefPubMed
12.
go back to reference Rouzier R, Pusztai L, Delaloge S, Gonzalez-Angulo AM, Andre F, Hess KR, Buzdar AU, Garbay JR, Spielmann M, Mathieu MC, et al. Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol. 2005;23(33):8331–9.CrossRefPubMed Rouzier R, Pusztai L, Delaloge S, Gonzalez-Angulo AM, Andre F, Hess KR, Buzdar AU, Garbay JR, Spielmann M, Mathieu MC, et al. Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol. 2005;23(33):8331–9.CrossRefPubMed
13.
go back to reference Colleoni M, Bagnardi V, Rotmensz N, Viale G, Mastropasqua M, Veronesi P, Cardillo A, Torrisi R, Luini A, Goldhirsch A. A nomogram based on the expression of Ki-67, steroid hormone receptors status and number of chemotherapy courses to predict pathological complete remission after preoperative chemotherapy for breast cancer. Eur J Cancer. 2010;46(12):2216–24.CrossRefPubMed Colleoni M, Bagnardi V, Rotmensz N, Viale G, Mastropasqua M, Veronesi P, Cardillo A, Torrisi R, Luini A, Goldhirsch A. A nomogram based on the expression of Ki-67, steroid hormone receptors status and number of chemotherapy courses to predict pathological complete remission after preoperative chemotherapy for breast cancer. Eur J Cancer. 2010;46(12):2216–24.CrossRefPubMed
14.
go back to reference Keam B, Im SA, Park S, Nam BH, Han SW, Oh DY, Kim JH, Lee SH, Han W, Kim DW, et al. Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy. J Cancer Res Clin Oncol. 2011;137(9):1301–8.CrossRefPubMed Keam B, Im SA, Park S, Nam BH, Han SW, Oh DY, Kim JH, Lee SH, Han W, Kim DW, et al. Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy. J Cancer Res Clin Oncol. 2011;137(9):1301–8.CrossRefPubMed
15.
16.
go back to reference Harrell Jr FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.CrossRefPubMed Harrell Jr FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.CrossRefPubMed
17.
go back to reference Steyerberg EW, Harrell Jr FE, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001;54(8):774–81.CrossRefPubMed Steyerberg EW, Harrell Jr FE, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001;54(8):774–81.CrossRefPubMed
18.
go back to reference DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.CrossRefPubMed DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.CrossRefPubMed
19.
go back to reference Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, Brachtel EF, Schapira L, Come SE, Winer EP, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012;131(3):1061–6.CrossRefPubMed Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, Brachtel EF, Schapira L, Come SE, Winer EP, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012;131(3):1061–6.CrossRefPubMed
20.
go back to reference Caudle AS, Gonzalez-Angulo AM, Hunt KK, Liu P, Pusztai L, Symmans WF, Kuerer HM, Mittendorf EA, Hortobagyi GN, Meric-Bernstam F. Predictors of tumor progression during neoadjuvant chemotherapy in breast cancer. J Clin Oncol. 2010;28(11):1821–8.CrossRefPubMedPubMedCentral Caudle AS, Gonzalez-Angulo AM, Hunt KK, Liu P, Pusztai L, Symmans WF, Kuerer HM, Mittendorf EA, Hortobagyi GN, Meric-Bernstam F. Predictors of tumor progression during neoadjuvant chemotherapy in breast cancer. J Clin Oncol. 2010;28(11):1821–8.CrossRefPubMedPubMedCentral
21.
go back to reference Precht LM, Lowe KA, Atwood M, Beatty JD. Neoadjuvant chemotherapy of breast cancer: tumor markers as predictors of pathologic response, recurrence, and survival. Breast J. 2010;16(4):362–8.PubMed Precht LM, Lowe KA, Atwood M, Beatty JD. Neoadjuvant chemotherapy of breast cancer: tumor markers as predictors of pathologic response, recurrence, and survival. Breast J. 2010;16(4):362–8.PubMed
22.
go back to reference Tan MC, Al Mushawah F, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA. Predictors of complete pathological response after neoadjuvant systemic therapy for breast cancer. Am J Surg. 2009;198(4):520–5.CrossRefPubMedPubMedCentral Tan MC, Al Mushawah F, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA. Predictors of complete pathological response after neoadjuvant systemic therapy for breast cancer. Am J Surg. 2009;198(4):520–5.CrossRefPubMedPubMedCentral
23.
go back to reference Mouret-Reynier M-A, Abrial CJ, Ferrière J-P, Amat S, Curé HD, Kwiatkowski FG, Feillel VA, Lebouëdec G, Penault-Llorca FM, Chollet PJM. Neoadjuvant FEC 100 for operable breast cancer: eight-year experience at centre jean Perrin. Clin Breast Cancer. 2004;5(4):303–7.CrossRefPubMed Mouret-Reynier M-A, Abrial CJ, Ferrière J-P, Amat S, Curé HD, Kwiatkowski FG, Feillel VA, Lebouëdec G, Penault-Llorca FM, Chollet PJM. Neoadjuvant FEC 100 for operable breast cancer: eight-year experience at centre jean Perrin. Clin Breast Cancer. 2004;5(4):303–7.CrossRefPubMed
24.
go back to reference Buzdar AU. Preoperative chemotherapy treatment of breast cancer--a review. Cancer. 2007;110(11):2394–407.CrossRefPubMed Buzdar AU. Preoperative chemotherapy treatment of breast cancer--a review. Cancer. 2007;110(11):2394–407.CrossRefPubMed
25.
go back to reference Jiang YZ, Yu KD, Peng WT, Di GH, Wu J, Liu GY, Shao ZM. Enriched variations in TEKT4 and breast cancer resistance to paclitaxel. Nat Commun. 2014;5:3802.PubMed Jiang YZ, Yu KD, Peng WT, Di GH, Wu J, Liu GY, Shao ZM. Enriched variations in TEKT4 and breast cancer resistance to paclitaxel. Nat Commun. 2014;5:3802.PubMed
26.
go back to reference Xiong X, Sui M, Fan W, Kraft AS. Cell-cycle dependent antagonistic interactions between paclitaxel and carboplatin in combination therapy. Cancer Biol Ther. 2014;6(7):1067–73.CrossRef Xiong X, Sui M, Fan W, Kraft AS. Cell-cycle dependent antagonistic interactions between paclitaxel and carboplatin in combination therapy. Cancer Biol Ther. 2014;6(7):1067–73.CrossRef
27.
go back to reference Pentheroudakis G, Razis E, Athanassiadis A, Pavlidis N, Fountzilas G. Paclitaxel-carboplatin combination chemotherapy in advanced breast cancer: accumulating evidence for synergy, efficacy, and safety. Med Oncol. 2006;23(2):147–60.CrossRefPubMed Pentheroudakis G, Razis E, Athanassiadis A, Pavlidis N, Fountzilas G. Paclitaxel-carboplatin combination chemotherapy in advanced breast cancer: accumulating evidence for synergy, efficacy, and safety. Med Oncol. 2006;23(2):147–60.CrossRefPubMed
28.
go back to reference Chen XS, Nie XQ, Chen CM, Wu JY, Wu J, Lu JS, Shao ZM, Shen ZZ, Shen KW. Weekly paclitaxel plus carboplatin is an effective nonanthracycline-containing regimen as neoadjuvant chemotherapy for breast cancer. Ann Oncol. 2010;21(5):961–7.CrossRefPubMed Chen XS, Nie XQ, Chen CM, Wu JY, Wu J, Lu JS, Shao ZM, Shen ZZ, Shen KW. Weekly paclitaxel plus carboplatin is an effective nonanthracycline-containing regimen as neoadjuvant chemotherapy for breast cancer. Ann Oncol. 2010;21(5):961–7.CrossRefPubMed
29.
go back to reference Gogas H, Pectasides D, Kostopoulos I, Lianos E, Skarlos D, Papaxoinis G, Bobos M, Kalofonos HP, Petraki K, Pavlakis K, et al. Paclitaxel and carboplatin as neoadjuvant chemotherapy in patients with locally advanced breast cancer: a phase II trial of the Hellenic cooperative oncology group. Clin Breast Cancer. 2010;10(3):230–7.CrossRefPubMed Gogas H, Pectasides D, Kostopoulos I, Lianos E, Skarlos D, Papaxoinis G, Bobos M, Kalofonos HP, Petraki K, Pavlakis K, et al. Paclitaxel and carboplatin as neoadjuvant chemotherapy in patients with locally advanced breast cancer: a phase II trial of the Hellenic cooperative oncology group. Clin Breast Cancer. 2010;10(3):230–7.CrossRefPubMed
30.
go back to reference Hurley J, Reis IM, Rodgers SE, Gomez-Fernandez C, Wright J, Leone JP, Larrieu R, Pegram MD. The use of neoadjuvant platinum-based chemotherapy in locally advanced breast cancer that is triple negative: retrospective analysis of 144 patients. Breast Cancer Res Treat. 2013;138(3):783–94.CrossRefPubMed Hurley J, Reis IM, Rodgers SE, Gomez-Fernandez C, Wright J, Leone JP, Larrieu R, Pegram MD. The use of neoadjuvant platinum-based chemotherapy in locally advanced breast cancer that is triple negative: retrospective analysis of 144 patients. Breast Cancer Res Treat. 2013;138(3):783–94.CrossRefPubMed
31.
go back to reference Farmer H, McCabe N, Lord CJ, Tutt AN, Johnson DA, Richardson TB, Santarosa M, Dillon KJ, Hickson I, Knights C, et al. Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature. 2005;434(7035):917–21.CrossRefPubMed Farmer H, McCabe N, Lord CJ, Tutt AN, Johnson DA, Richardson TB, Santarosa M, Dillon KJ, Hickson I, Knights C, et al. Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature. 2005;434(7035):917–21.CrossRefPubMed
Metadata
Title
A nomogram for predicting pathological complete response in patients with human epidermal growth factor receptor 2 negative breast cancer
Authors
Xi Jin
Yi-Zhou Jiang
Sheng Chen
Ke-Da Yu
Ding Ma
Wei Sun
Zhi-Min Shao
Gen-Hong Di
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2652-z

Other articles of this Issue 1/2016

BMC Cancer 1/2016 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine