Pathological complete response pCR of axillary lymph node LN is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy NAC. This study investigated the predictive value of axillary response following NAC and evaluated the predictive value of a model based on axillary response. Data prospectively collected on patients with clinically node-positive breast cancer who were treated Yonghwa dating 2019 ford NAC Yonghwa dating 2019 ford underwent axillary LN dissection ALND were retrieved.
A model predictive of axillary pCR was developed based on clinicopathologic variables. The overall predictive ability between models was compared by receiver operating characteristic ROC curve analysis. The area under the ROC curve for estimating axillary pCR was significantly higher in the model that included tumor response rate than in the model that excluded this rate 0.
Tumor response rate was the most significant independent predictor of axillary pCR in response to NAC.
The model that included tumor response rate was a significantly better predictor of axillary pCR than the model that excluded tumor response rate. Neoadjuvant chemotherapy NAC is currently regarded as the standard and primary treatment for patients with locally advanced breast cancer [ 12 ]. Axillary lymph node LN status is an important prognostic factor in breast cancer patients, being associated with the risk of locoregional recurrence and metastasis and guiding locoregional and systemic
Yonghwa dating 2019 ford decisions.
NAC reduces breast tumor burden, increasing the ability to perform breast conservation and axillary conservation surgery [ 3456 ]. Another advantage of NAC is that long-term prognosis, including locoregional and survival outcomes, is improved in patients who achieve pathologic complete response pCR in the breast and axilla [ 78 ], with nodal pCR being a more important prognostic factor than breast pCR [ 79 ].
In addition, axillary LN dissection ALND be omitted for patients who achieve axillary pCR, avoiding postoperative complications such as lymphedema, arm pain, and reduced arm movement [ 1112 ]. Few previous studies have evaluated methods to improve the ability of axillary LN status to predict axillary pCR, and to improve the accuracy of SLNB in patients with clinically node-positive breast cancer after NAC.
Therefore, additional tools may prove helpful in estimating axillary nodal response to NAC in patients with "Yonghwa dating 2019 ford" node-positive breast cancer, and in identifying which patients who do not require ALND. Models have been designed to predict the probabilities or risks of clinical outcomes, thereby assisting clinicians and patients in determining how to manage breast cancer [ 1415 ].
These models have limitations, however, because they did not evaluate tumor response after NAC, but because they were not validated using data from an institution not involved in model development. This study evaluated factors predictive of axillary pCR and compared the model based on our data, which approximates the accuracy of axillary LN status, to identify patients with clinically node-positive breast cancer who achieved axillary pCR after NAC.
"Yonghwa dating 2019 ford" total of 2, patients underwent surgery for malignant breast cancer at the Seoul St. Data were prospectively collected from all patients and reviewed retrospectively. Of these patients, Yonghwa dating 2019 ford were excluded, including 43 without cytologically proven axillary LN metastasis, six who received another chemotherapy regimen, and 10 who discontinued NAC before completion.
The remaining patients were confirmed as having axillary LN metastasis and underwent radical operation of the primary tumor with concurrent ALND.
Yonghwa dating 2019 ford the patients received sequential chemotherapy or combination chemotherapy, consisting of anthracycline and taxane. Tumor and axillary LN response rates were evaluated on breast MRI by two experienced radiologists based on visual assessments and calculations. The tumor response rate was calculated as the percentage of tumors and "Yonghwa dating 2019 ford" LNs showing reductions in size according to the Response Evaluation Criteria Yonghwa dating 2019 ford Solid Tumors 1.
The longest tumor diameter and a short axis axillary LN diameter greater than 1. Yonghwa dating 2019 ford lesion diameters are calculated as the sum of the diameters of all lesions.
Clinical response was classified as complete response CRpartial response, stable disease, or progressive disease PD. Biopsy samples were assayed for expression of estrogen receptor ERprogesterone receptor PRhuman epidermal growth factor receptor 2 HER2and Ki, and their histologic grade was evaluated. Breast cancers into the four different subtypes: All IHC results were interpreted by a single pathologist. The predictive accuracy of models estimating residual nodal metastasis in patients with clinically node positive breast cancer after NAC was determined by receiver operating characteristic ROC curve analysis.
To develop a new model, the dataset was analyzed by univariate and multivariate logistic regression analysis. This new model was used to predict the likelihood of patients achieving axillary pCR to NAC. The discriminatory performance of each Yonghwa dating 2019 ford, defined as its ability to distinguish among patients with different responses or events, was assessed by measuring the area under ROC curves AUC. The statistical differences among different AUCs were also investigated.
Differences in continuous variables between groups of patients who did and did not achieve axillary pCR were assessed by the t-test or Wilcoxon rank sum test, and differences in categorical variables were analyzed by the chi-square test or Fisher exact test. The predictive performance of each model was presented as sensitivity, specificity, positive predictive value PPVand negative predictive value NPVwith differences between models calculated by comparing AUCs.
All statistical analyses were
Yonghwa dating 2019 ford using SAS version 9. Of the women investigated, 68 Tumors with higher histologic grade and higher Ki expression were significantly more common in patients did than did not achieve axillary pCR. In contrast, negative ER and PR status, positive HER2 status, and tumors with early clinical and nodal stage did not differ significantly in the two groups.
Mean tumor diameters before and after NAC were 4. Tumor and axillary LN sizes throughout treatment were significantly smaller in patients who did than did not achieve axillary pCR. The clinical CR rate was significantly higher in patients who did than did not achieve axillary pCR The mean overall tumor response rate was significantly higher in patients who did than did not achieve axillary pCR The median tumor response rate for all patients was Using the median as the cutoff value, we found that tumor response rate was significantly higher in patients who did than did not achieve axillary pCR Table 3 shows univariate and multivariate analyses of factors possible predictive of achieving axillary LN pCR.
Previous studies have shown that axillary pCR was associated with younger age, high histologic grade, high levels of Ki expression, ER-negativity, and HER2-positivity [ 1415 ]. We constructed a basic model based on these results and statistically significant variables in our study, including age, ER-status, HER2-status, histologic "Yonghwa dating 2019 ford," and Ki expression, to determine whether this model could predict the probability of our patients achieving axillary pCR.
We eliminated the negative effect of our small-size population, which was shown to result in a wide CI. We then attempted to develop a new model, based on the independent predictors of axillary pCR shown in our multivariate logistic regression analysis.
We found that the model that included tumor response rate had a sensitivity of We found that, compared with other predictive factors including clinical response and axillary LN size after NAC, the tumor response rate was the most important predictor and enhanced the performance of our model. Of these factors, tumor response rate Yonghwa dating 2019 ford one of the most reliable and should be included in models predicting axillary response.
Other models for predicting axillary LN pCR have included factors unrelated to nodal status and did not include tumor response rate after NAC [ 14
Yonghwa dating 2019 ford, 15 ]. Our model, which included tumor response rate, was a better predictor of the probability of achieving axillary LN pCR. A comparison of models that did and did not include tumor response rate found that the model that included response rate, as evaluated by breast MRI, had a significantly improved predicted accuracy, with an AUC of 0.
However, current guidelines for the standard management of patients who "Yonghwa dating 2019 ford" CR have not been adjusted accordingly, despite high nodal pCR rates [ 20 ]. Most patients with axillary LN metastases before NAC undergo ALND, which has been associated with complication such as lymphedema, arm pain, and reduced arm movement due
Yonghwa dating 2019 ford shoulder dysfunction [ 11122122 ]. To better understand patient outcomes and to identify patients who can omit ALND, it is necessary to improve the accuracy of axillary nodal status based on SLNB.
Accurate identification of the
Yonghwa dating 2019 ford in patients likely to achieve nodal pCR, who may benefit from axilla-conserving surgery, is difficult.
The accurate determination of axillary nodal status may be improved by the detection of two or more SLNs, by using a dual-tracer for mapping, by using IHC for pathologic evaluation, and by ensuring the removal of the axillary LN initially identified as being a nodal metastasis by marking with a clip [ 23 ].
Therefore, in developing a model with improved performance, we added noninvasive predicting factors such as tumor response rate. Although clinical responses may be Yonghwa dating 2019 ford of axillary pCR in response to NAC, many patients do not achieve clinical CR, with most patients who receive NAC achieving partial response. Therefore, clinical response is predictive of axillary pCR in few patients. Because we found that tumor response rate was associated with axillary pCR and may be predictive in patients, we incorporated tumor response rate into our model.
We also showed that tumor response could be easily determined by measuring tumor diameter Yonghwa dating 2019 ford axillary LN diameter on breast MRI. Radiologic results have shown diagnostic value in evaluating axillary LN metastases after NAC, with combinations that included MRI showing greater sensitivity in detecting positive axillary LN metastases [ 24 ]. Tumor response rate is an easily measured clinicopathologic variable, allowing simple and rapid prediction of axillary pCR.
This parameter can be used Yonghwa dating 2019 ford making treatment decisions and in clinical trials [ 25 ]. Patients with a higher tumor response rate are more likely to achieve axillary LN pCR. SLNBs negative for metastases indicate that ALND can Yonghwa dating 2019 ford safely omitted, thereby avoiding the postoperative complications of this procedure. Our study had several Yonghwa dating 2019 ford compared with previous Yonghwa dating 2019 ford predicting axillary pCR after NAC in patients with cytologically proven nodal metastasis [ 141526 ].
Most importantly, these previous studies did not include tumor and nodal response rates to NAC. Tumor response rate offers several advantages compared with alternative methods for assessing axillary pCR after NAC.
First, in contrast to SLNB, the prediction of axillary pCR based on tumor response rate is non-invasive, reducing associated morbidity. Second, because breast MRI is included in standard workup of patients with breast cancer before, tumor response rate can be readily calculated by comparing MRI results before and after NAC.
Moreover, this procedure is covered by the national health insurance in Korea, eliminating the need for additional procedures, such as diagnostic tests and surgical procedures. Third, core needle biopsy was used to confirm all patients with axillary LN metastases before NAC, making our results more accurate than those of previous studies. Our study also had several limitations.
First, it was retrospective in design, involving a limited number of patients at a single institution. The study results were not validated externally, and median tumor response rate may have limited the generalizability of our findings. The false negative rate of SLNB is an important indicator cytologically confirmed nodal metastasis.
Assessments of tumor response Yonghwa dating 2019 ford to NAC using combinations of radiologic measurements are required, as are well-controlled, prospective studies in large numbers of patients. In conclusion, this study evaluated the ability of various factors to predict axillary LN pCR in breast cancer Yonghwa dating 2019 ford treated with NAC and compared models based on these predictors.
Use of models that include tumor response rates may avoid the need for unnecessary axillary LN dissection. The authors declare that they have no competing interests. National Center for Biotechnology InformationU. Journal List J Breast Cancer v.
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To date, clinically node- positive patients have undergone ALND. ;– Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. RELEASE DATE: "Yonghwa dating 2019 ford" 2, On October 2,Switchblade Pictures will be releasing Director: Kim Yong-Hwa Writer: Kim Yong-Hwa Cast: Ha Jung- Woo, Ju Ji-Hoon, Van Damme to show 'Eagle Path' some 'Full Love' in.
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