1. International multicenter tool to predict the risk of nonsentinel node metastases in breast cancer
- Author
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E. Barranger, György Lázár, Tove Flitenborg Tvedskov, Simonetta Bianchi, G. Luschin-Ebengreuth, Gábor Boross, Janez Žgajnar, Peter Regitnig, Rana Nadeem, András Vörös, Tibor Takács, Andraz Perhavec, Gábor Cserni, Vania Vezzosi, Hiroshi Kamma, Maria Pia Foschini, Maj Brit Jensen, Riccardo Arisio, Niels Thorndahl Kroman, Shigeru Imoto, Barbara Gazić, Zuhair Saidan, Päivi Heikkilä, R. Lousquy, Tuomo J. Meretoja, István Sejben, Anna Sapino, Riccardo A. Audisio, Isabella Castellano, Marjut Leidenius, Meretoja TJ, Leidenius MH, Heikkilä PS, Boross G, Sejben I, Regitnig P, Luschin-Ebengreuth G, Zgajnar J, Perhavec A, Gazic B, Lázár G, Takács T, Vörös A, Saidan ZA, Nadeem RM, Castellano I, Sapino A, Bianchi S, Vezzosi V, Barranger E, Lousquy R, Arisio R, Foschini MP, Imoto S, Kamma H, Tvedskov TF, Kroman N, Jensen MB, Audisio RA, and Cserni G.
- Subjects
Cancer Research ,medicine.medical_treatment ,International Cooperation ,Logistic regression ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Frozen Sections ,0303 health sciences ,Carcinoma, Ductal, Breast ,Confounding Factors, Epidemiologic ,Sentinel node ,Middle Aged ,Immunohistochemistry ,3. Good health ,Europe ,Oncology ,030220 oncology & carcinogenesis ,Predictive value of tests ,Area Under Curve ,Lymphatic Metastasis ,PREDICTIVE TOOL ,Female ,Radiology ,Breast disease ,Adult ,medicine.medical_specialty ,Breast surgery ,Breast Neoplasms ,Risk Assessment ,03 medical and health sciences ,Breast cancer ,BREAST CANCER ,Predictive Value of Tests ,medicine ,Humans ,030304 developmental biology ,Aged ,Neoplasm Staging ,Retrospective Studies ,Analysis of Variance ,business.industry ,Sentinel Lymph Node Biopsy ,Axillary Lymph Node Dissection ,Reproducibility of Results ,medicine.disease ,Confidence interval ,Surgery ,Carcinoma, Lobular ,SENTINEL NODE ,Logistic Models ,ROC Curve ,AXILLARY DISSECTION ,Axilla ,Lymph Node Excision ,Lymph Nodes ,Neoplasm Grading ,business - Abstract
Background Axillary treatment of breast cancer patients is undergoing a paradigm shift, as completion axillary lymph node dissections (ALNDs) are being questioned in the treatment of patients with tumor-positive sentinel nodes. This study aims to develop a novel multi-institutional predictive tool to calculate patient-specific risk of residual axillary disease after tumor-positive sentinel node biopsy. Methods Breast cancer patients with a tumor-positive sentinel node and a completion ALND from five European centers formed the original patient series (N = 1000). Statistically significant variables predicting nonsentinel node involvement were identified in logistic regression analysis. A multivariable predictive model was developed and validated by area under the receiver operating characteristics curve (AUC), first internally in 500 additional patients and then externally in 1068 patients from other centers. All statistical tests were two-sided. Results Nine tumor- and sentinel node-specific variables were identified as statistically significant factors predicting nonsentinel node involvement in logistic regression analysis. A resulting predictive model applied to the internal validation series resulted in an AUC of 0.714 (95% confidence interval [CI] = 0.665 to 0.763). For the external validation series, the AUC was 0.719 (95% CI = 0.689 to 0.750). The model was well calibrated in the external validation series. Conclusions We present a novel, international, multicenter, predictive tool to assess the risk of additional axillary metastases after tumor-positive sentinel node biopsy in breast cancer. The predictive model performed well in internal and external validation but needs to be further studied in each center before application to clinical use.
- Published
- 2012