Nomogram to predict pathologic complete response in HER2-positive breast cancer treated with neoadjuvant systemic therapy
Menée à partir de données portant sur 793 patientes atteintes d'un cancer primitif du sein HER2+ de stade I à III, cette étude évalue la performance d'un nomogramme, basé sur le rapport HER2/CEP17, l'expression des récepteurs aux estrogènes et à la progestérone, le caractère inflammatoire de la tumeur et l'utilisation de trastuzumab en combinaison ou non avec le pertuzumab, pour prédire le taux de réponse complète pathologique après un traitement systémique néo-adjuvant
Background : Pathologic complete response (pCR) is associated with improved survival outcomes in patients with HER2-positive primary breast cancer. We developed a nomogram to predict the probability of pCR rates by using oestrogen receptor (ER) expression, progesterone receptor (PR) expression and HER2/CEP17 ratio as continuous variables.
Methods : We retrospectively reviewed patients with stages I–III HER2-positive invasive breast cancer who had definitive surgery in 1999–2015 and received neoadjuvant systemic therapy (NST). Multivariate logistic regression models were applied to assess the effect of variables on pCR. A nomogram was built to estimate the probability of pCR. The discriminative ability was estimated by the concordance index (C-index). The accuracy was assessed graphically with a calibration curve.
Results : A total of 793 patients were included in the analysis. Low ER expression (P<0.001), high HER2/CEP12 ratio (P=0.03), and non-inflammatory breast cancer subtype (P=0.003) were associated with increased pCR rates. Regimens containing trastuzumab or trastuzumab and pertuzumab were associated with higher pCR rates than cytotoxic agents alone (P<0.001 and P<0.001, respectively). The C-index was 0.69. The calibration curve showed good agreement.
Conclusions : Our nomogram predicted the pCR rate after NST among patients with HER2-positive primary breast cancer using clinicopathologic factors.
British Journal of Cancer , résumé, 2016