A Novel Nomogram for Predicting Prognosis and Tailoring Local Therapy Decision for Ductal Carcinoma In Situ after Breast Conserving Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Cohort
2.2. Pathological and Mammographic Examination
2.3. Adjuvant Radiotherapy
2.4. Outcomes’ Definitions
2.5. Development and Validation of the Nomogram
2.6. Statistical Analysis
3. Results
3.1. Patient and Treatment Characteristics
3.2. IBTR Events and Survival Outcomes
3.3. Relationship between NLR and TNBC
3.4. Nomogram Development
3.5. Performance of the Nomogram and Internal Validation
3.6. IBTR Risk Group
3.7. Benefit from WBI According to IBTR Risk Groups
3.8. Pattern of IBTR with Regard to Risk Groups
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Characteristics | Whole Cohort | BCS Only | BCS + WBI | p Value | |||
---|---|---|---|---|---|---|---|
n = 259 | % | n= 77 | % | n = 182 | % | ||
Age (years) | |||||||
Median (range) | 49 (25–92) | 52 (25–92) | 48(26–80) | ||||
<40 | 39 | 15.1 | 8 | 10.4 | 31 | 17 | 0.19 |
≥40 | 220 | 84.9 | 69 | 89.6 | 151 | 83 | |
Menopausal status | 0.02 | ||||||
Premenopausal | 137 | 52.9 | 32 | 41.6 | 105 | 57.7 | |
Postmenopausal | 122 | 47.1 | 45 | 58.4 | 77 | 42.3 | |
Tumour size (cm) | |||||||
Median (range) | 1.5 (0.1–5.0) | 1.0 (0.15–3.5) | 1.5 (0.1–5.0) | ||||
≤2.5 | 235 | 90.7 | 72 | 93.5 | 163 | 89.6 | 0.36 |
>2.5 | 24 | 9.3 | 5 | 6.5 | 19 | 10.4 | |
Nuclear grade | |||||||
Low-Intermediate | 178 | 68.7 | 60 | 77.9 | 118 | 64.8 | 0.04 |
High | 81 | 31.3 | 17 | 22.1 | 64 | 35.2 | |
Comedo-necrosis | |||||||
Yes | 59 | 22.8 | 16 | 20.8 | 43 | 23.6 | 0.75 |
No | 220 | 77.2 | 61 | 79.2 | 139 | 76.4 | |
Microinvasion | |||||||
Yes | 48 | 18.5 | 9 | 11.7 | 39 | 21.4 | 0.08 |
No | 211 | 81.5 | 68 | 88.3 | 143 | 78.6 | |
ER status | |||||||
Positive | 184 | 71.0 | 55 | 71.4 | 129 | 70.9 | 1.00 |
Negative | 75 | 29.0 | 22 | 28.6 | 53 | 29.1 | |
Ki67 index | |||||||
≤14% | 166 | 64.1 | 54 | 70.1 | 112 | 61.5 | 0.21 |
>14% | 93 | 35.9 | 23 | 29.9 | 70 | 38.5 | |
HER2 status | |||||||
Positive | 54 | 20.8 | 14 | 18.2 | 40 | 22 | 0.62 |
Negative | 205 | 79.2 | 63 | 81.8 | 142 | 78 | |
Mammographic-clustered microcalcifications | |||||||
Yes | 86 | 33.2 | 25 | 32.5 | 61 | 33.5 | 1.00 |
No | 173 | 66.8 | 52 | 67.5 | 121 | 66.5 | |
Preop-NLR | |||||||
≤1.1 | 73 | 28.2 | 12 | 15.6 | 61 | 33.5 | 0.01 |
>1.1 | 186 | 71.8 | 65 | 84.4 | 121 | 66.5 | |
Axillary surgery | |||||||
SLNB | 117 | 45.2 | 31 | 40.3 | 86 | 47.3 | 0.56 |
ALND | 17 | 6.6 | 5 | 6.5 | 12 | 6.6 | |
No surgery | 125 | 48.3 | 41 | 53.2 | 84 | 46.2 | |
Endocrine therapy in ER positive (n = 184) | 0.21 | ||||||
Yes | 151 | 82.1 | 42 | 76.4 | 109 | 84.5 | |
No | 33 | 17.9 | 13 | 23.6 | 20 | 15.5 | |
Target therapy | |||||||
Yes | 1 | 0.4 | 0 | 0 | 1 | 0.5 | 0.52 |
No | 258 | 99.6 | 77 | 100 | 181 | 99.5 | |
Chemotherapy | |||||||
Yes | 6 | 2.3 | 1 | 1.3 | 5 | 2.7 | 0.48 |
No | 253 | 97.7 | 76 | 98.7 | 177 | 97.3 |
Characteristics | IBTR | |||||
---|---|---|---|---|---|---|
Univariate Analyses | Multivariable Analyses | |||||
n of IBTR | 5-Year Rate | p Value | HR | 95% CI | p Value | |
Age (years) | 0.77 | |||||
<40 | 3 | 14.5 | ||||
≥40 | 13 | 7.4 | ||||
Menopausal status | 0.53 | |||||
Premenopausal | 10 | 12.3 | ||||
Postmenopausal | 6 | 5.9 | ||||
Tumour size (cm) | ||||||
≤2.5 | 12 | 8.1 | 0.04 | 1 | ||
>2.5 | 4 | 19.8 | 2.04 | 0.58–7.13 | 0.27 | |
Nuclear grade | 0.04 | |||||
Low-Intermediate | 8 | 5.4 | 1 | |||
High | 8 | 19.2 | 0.74 | 0.25–2.15 | 0.57 | |
Comedo-necrosis | 0.17 | |||||
Yes | 6 | 17.1 | ||||
No | 10 | 7.2 | ||||
Microinvasion | <0.01 | |||||
Yes | 7 | 24.7 | 1 | |||
No | 9 | 6.1 | 3.37 | 1.11–10.20 | 0.03 | |
ER status | <0.01 | |||||
Positive | 7 | 5.1 | 1 | |||
Negative | 9 | 20.6 | 0.66 | 0.18–2.43 | 0.53 | |
Ki67 index | <0.01 | |||||
≤14% | 3 | 1.8 | 1 | |||
>14% | 13 | 24.0 | 5.63 | 1.47–21.55 | 0.01 | |
HER2 status | <0.01 | |||||
Positive | 8 | 29.1 | 1 | |||
Negative | 8 | 4.5 | 1.17 | 0.34–3.92 | 0.80 | |
Mammographic-clustered microcalcifications | 0.01 | |||||
Yes | 11 | 16.3 | 1 | |||
No | 5 | 5.4 | 3.32 | 1.12–9.85 | 0.03 | |
Preop-NLR | 0.01 | |||||
≤1.1 | 1 | 2.2 | 1 | |||
>1.1 | 15 | 12.9 | 7.87 | 0.99–62.63 | 0.05 | |
Axillary surgery | 0.41 | |||||
SLNB | 9 | 13.7 | ||||
ALND | 1 | 16.7 | ||||
No surgery | 6 | 5.2 |
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Xu, F.; Cao, L.; Xu, C.; Cai, G.; Cai, R.; Qi, W.; Wang, S.; Shen, K.; Chai, W.; Chen, J. A Novel Nomogram for Predicting Prognosis and Tailoring Local Therapy Decision for Ductal Carcinoma In Situ after Breast Conserving Surgery. J. Clin. Med. 2022, 11, 5188. https://doi.org/10.3390/jcm11175188
Xu F, Cao L, Xu C, Cai G, Cai R, Qi W, Wang S, Shen K, Chai W, Chen J. A Novel Nomogram for Predicting Prognosis and Tailoring Local Therapy Decision for Ductal Carcinoma In Situ after Breast Conserving Surgery. Journal of Clinical Medicine. 2022; 11(17):5188. https://doi.org/10.3390/jcm11175188
Chicago/Turabian StyleXu, Feifei, Lu Cao, Cheng Xu, Gang Cai, Rong Cai, Weixiang Qi, Shubei Wang, Kunwei Shen, Weimin Chai, and Jiayi Chen. 2022. "A Novel Nomogram for Predicting Prognosis and Tailoring Local Therapy Decision for Ductal Carcinoma In Situ after Breast Conserving Surgery" Journal of Clinical Medicine 11, no. 17: 5188. https://doi.org/10.3390/jcm11175188