Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine c...Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients.Methods： Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set（378 cases） and validated in an independent validation set（126 cases）. A Youdenderived cut-off value was assigned to the nomogram for accuracy evaluation.Results： The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node（LN） status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve（AUC） values were 0.905 [95% confidence interval（95% CI）： 0.876–0.934] and 0.883（95%CI： 0.824–0.942） in the training and validation sets, respectively. The accuracies of the nomogram for ACR were84.4% in the training set and 82.1% in the validation set.Conclusions： We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.展开更多
Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer.This study aimed to evaluate the prognostic significance of the 21-gene recurrence score(RS)in Chinese patients with...Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer.This study aimed to evaluate the prognostic significance of the 21-gene recurrence score(RS)in Chinese patients with pN0-l,estrogen receptor-positive(ER+),human epidermal growth factor receptor 2-negative(HER2)breast cancer.Among 800 patients recruited between 2009 and 2016,the median RS was 24(0-69),with 27.4%,46.8%,and 25.9%patients classified into low-,intermediate-,and high-risk groups.Cox regression analysis demonstrated that the high-risk category was associated with significantly higher odds of invasive disease-free survival(IDFS)and distant disease-free survival(DDFS)events compared with the low-risk category(IDFS:HR=2.450,95%Cl 1.017-5.902,P=0.046;DDFS:HR=2.829,95%Cl 1.013-7.901,P=0.047).No significant association between RS category and overall survival(OS)was found(intermediate vs.low:HR=1.244,95%Cl 0.292-5.297,P=0.768;high vs.low:HR=2.933,95%Cl 0.759-11.327,P=0.119).RS,as a continuous variable,was a highly significant predictor for IDFS(HR=1.028,95%Cl 1.010-1.047,P=0.002),DDFS(HR=1.030,95%Cl 1.010-1.051,P=0.003),and OS(HR=1.034,95%Cl 1.007-1.063,P=0.014).Our findings suggested that RS may predict IDFS in Chinese patients with ER+/HER2 breast cancer with NO or N1 disease.展开更多
BACKGROUND Pancreatectomy with concomitant portomesenteric vein resection(PVR)enables patients with portomesenteric vein(PV)involvement to achieve radical resection of pancreatic ductal adenocarcinoma,however,early re...BACKGROUND Pancreatectomy with concomitant portomesenteric vein resection(PVR)enables patients with portomesenteric vein(PV)involvement to achieve radical resection of pancreatic ductal adenocarcinoma,however,early recurrence(ER)is frequently observed.AIM To predict ER and identify patients at high risk of ER for individualized therapy.METHODS Totally 238 patients undergoing pancreatectomy and PVR were retrospectively enrolled and were allocated to the training or validating cohort.Univariate Cox and LASSO regression analyses were performed to construct serum recurrence score(SRS)based on 26 serum-derived parameters.Uni-and multivariate Cox regression analyses of SRS and 18 clinicopathological variables were performed to establish a Nomogram.Receiver operating characteristic curve analysis was used to evaluate the predictive accuracy.Survival analysis was performed using Kaplan-Meier method and log-rank test.RESULTS Independent serum-derived recurrence-relevant factors of LASSO regression model,including postoperative carbohydrate antigen 19-9,postoperative carcinoembryonic antigen,postoperative carbohydrate antigen 125,preoperative albumin(ALB),preoperative platelet to ALB ratio,and postoperative platelets to lymphocytes ratio,were used to construct SRS[area under the curve(AUC):0.855,95%CI:0.786–0.924].Independent risk factors of recurrence,including SRS[hazard ratio(HR):1.688,95%CI:1.075-2.652],pain(HR:1.653,95%CI:1.052-2.598),perineural invasion(HR:2.070,95%CI:0.827-5.182),and PV invasion(HR:1.603,95%CI:1.063-2.417),were used to establish the recurrence nomogram(AUC:0.869,95%CI:0.803-0.934).Patients with either SRS>0.53 or recurrence nomogram score>4.23 were considered at high risk for ER,and had poor long-term outcomes.CONCLUSION The recurrence scoring system unique for pancreatectomy and PVR,will help clinicians in predicting recurrence efficiently and identifying patients at high risk of ER for individualized therapy.展开更多
Background:The 21-gene recurrence score(RS)assay has been recommended by major guidelines for treatment decision in hormone receptor(HR)-positive early breast cancer(EBC).However,the genomic assay is not accessible an...Background:The 21-gene recurrence score(RS)assay has been recommended by major guidelines for treatment decision in hormone receptor(HR)-positive early breast cancer(EBC).However,the genomic assay is not accessible and affordable worldwide.Alternatively,an increasing number of studies have shown that traditional immunohistochemistry(IHC)can partially or even completely replace the role of the 21-gene genomic assay.Here,we developed and validated a predictive model(IHC3 model)combining the Ki-67 index,progesterone receptor(PR)expression,histologic grade,and tumor size to predict the recurrence risk of HR-positive EBC.Methods:The data from 389 patients(development set)with HR-positive,human epidermal growth factor receptor 2-negative,lymph node non-metastasized invasive breast cancer were used to construct the IHC3 model based on the Surexam®21-gene RS and the TAILORx clinical trial criteria.An additional 146 patients with the same characteristics constituted the validation set.The predictive accuracy of the IHC3 model was compared with that of Orucevic et al.’s nomogram.Invasive diseasefree survival(IDFS)was analyzed in the IHC3 predictive low-recurrence risk(pLR)group and the predictive high-recurrence risk(pHR)group.The Pearson chi-square test,Fisher exact test,and log-rank test were used for analysis.Results:The pLR and pHR group could be easily stratified using the decision tree model without network dependence.The accuracies of the IHC3 model were 86.1%in the development set and 87.7%in the validation set.The predictive accuracy of the IHC3 model and Orucevic et al.’s nomogram for the whole cohort was 86.5%and 86.9%,respectively.After a 52-month of median follow-up,a significant difference was found in IDFS between of the IHC3 pLR and the pHR groups(P=0.001)but not in the IDFS between the low-and high-recurrence risk groups according to the Surexam®21-gene RS and the TAILORx clinical trial criteria(P=0.556)or 21-gene binary RS group(P=0.511).Conclusions:The proposed IHC3 model could reliably predict low and high recurrence risks in most HR-positive EBC patients.This easy-to-use predictive model may be a reliable replacement for the 21-gene genomic assay in patients with EBC who have no access to or cannot afford the 21-gene genomic assay.展开更多
文摘Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients.Methods： Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set（378 cases） and validated in an independent validation set（126 cases）. A Youdenderived cut-off value was assigned to the nomogram for accuracy evaluation.Results： The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node（LN） status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve（AUC） values were 0.905 [95% confidence interval（95% CI）： 0.876–0.934] and 0.883（95%CI： 0.824–0.942） in the training and validation sets, respectively. The accuracies of the nomogram for ACR were84.4% in the training set and 82.1% in the validation set.Conclusions： We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.
基金This work was supported by grants from the Technology Innovation Act Plan of Shanghai Municipal Science and Technology Commission(Nos.14411-950200 and 14411950201)the National Natural Science Foundation of China(No.81772797)the Shanghai Municipal Commission of Health and Family Planning(No.201840323)。
文摘Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer.This study aimed to evaluate the prognostic significance of the 21-gene recurrence score(RS)in Chinese patients with pN0-l,estrogen receptor-positive(ER+),human epidermal growth factor receptor 2-negative(HER2)breast cancer.Among 800 patients recruited between 2009 and 2016,the median RS was 24(0-69),with 27.4%,46.8%,and 25.9%patients classified into low-,intermediate-,and high-risk groups.Cox regression analysis demonstrated that the high-risk category was associated with significantly higher odds of invasive disease-free survival(IDFS)and distant disease-free survival(DDFS)events compared with the low-risk category(IDFS:HR=2.450,95%Cl 1.017-5.902,P=0.046;DDFS:HR=2.829,95%Cl 1.013-7.901,P=0.047).No significant association between RS category and overall survival(OS)was found(intermediate vs.low:HR=1.244,95%Cl 0.292-5.297,P=0.768;high vs.low:HR=2.933,95%Cl 0.759-11.327,P=0.119).RS,as a continuous variable,was a highly significant predictor for IDFS(HR=1.028,95%Cl 1.010-1.047,P=0.002),DDFS(HR=1.030,95%Cl 1.010-1.051,P=0.003),and OS(HR=1.034,95%Cl 1.007-1.063,P=0.014).Our findings suggested that RS may predict IDFS in Chinese patients with ER+/HER2 breast cancer with NO or N1 disease.
基金Supported by National Natural Science Foundation of China,No.82373012.
文摘BACKGROUND Pancreatectomy with concomitant portomesenteric vein resection(PVR)enables patients with portomesenteric vein(PV)involvement to achieve radical resection of pancreatic ductal adenocarcinoma,however,early recurrence(ER)is frequently observed.AIM To predict ER and identify patients at high risk of ER for individualized therapy.METHODS Totally 238 patients undergoing pancreatectomy and PVR were retrospectively enrolled and were allocated to the training or validating cohort.Univariate Cox and LASSO regression analyses were performed to construct serum recurrence score(SRS)based on 26 serum-derived parameters.Uni-and multivariate Cox regression analyses of SRS and 18 clinicopathological variables were performed to establish a Nomogram.Receiver operating characteristic curve analysis was used to evaluate the predictive accuracy.Survival analysis was performed using Kaplan-Meier method and log-rank test.RESULTS Independent serum-derived recurrence-relevant factors of LASSO regression model,including postoperative carbohydrate antigen 19-9,postoperative carcinoembryonic antigen,postoperative carbohydrate antigen 125,preoperative albumin(ALB),preoperative platelet to ALB ratio,and postoperative platelets to lymphocytes ratio,were used to construct SRS[area under the curve(AUC):0.855,95%CI:0.786–0.924].Independent risk factors of recurrence,including SRS[hazard ratio(HR):1.688,95%CI:1.075-2.652],pain(HR:1.653,95%CI:1.052-2.598),perineural invasion(HR:2.070,95%CI:0.827-5.182),and PV invasion(HR:1.603,95%CI:1.063-2.417),were used to establish the recurrence nomogram(AUC:0.869,95%CI:0.803-0.934).Patients with either SRS>0.53 or recurrence nomogram score>4.23 were considered at high risk for ER,and had poor long-term outcomes.CONCLUSION The recurrence scoring system unique for pancreatectomy and PVR,will help clinicians in predicting recurrence efficiently and identifying patients at high risk of ER for individualized therapy.
基金This study was funded by the science and technology commission of Beijing:Optimization of breast cancer screening program for 35-75 years old women in Beijing(Grant No.D161100000816005)。
文摘Background:The 21-gene recurrence score(RS)assay has been recommended by major guidelines for treatment decision in hormone receptor(HR)-positive early breast cancer(EBC).However,the genomic assay is not accessible and affordable worldwide.Alternatively,an increasing number of studies have shown that traditional immunohistochemistry(IHC)can partially or even completely replace the role of the 21-gene genomic assay.Here,we developed and validated a predictive model(IHC3 model)combining the Ki-67 index,progesterone receptor(PR)expression,histologic grade,and tumor size to predict the recurrence risk of HR-positive EBC.Methods:The data from 389 patients(development set)with HR-positive,human epidermal growth factor receptor 2-negative,lymph node non-metastasized invasive breast cancer were used to construct the IHC3 model based on the Surexam®21-gene RS and the TAILORx clinical trial criteria.An additional 146 patients with the same characteristics constituted the validation set.The predictive accuracy of the IHC3 model was compared with that of Orucevic et al.’s nomogram.Invasive diseasefree survival(IDFS)was analyzed in the IHC3 predictive low-recurrence risk(pLR)group and the predictive high-recurrence risk(pHR)group.The Pearson chi-square test,Fisher exact test,and log-rank test were used for analysis.Results:The pLR and pHR group could be easily stratified using the decision tree model without network dependence.The accuracies of the IHC3 model were 86.1%in the development set and 87.7%in the validation set.The predictive accuracy of the IHC3 model and Orucevic et al.’s nomogram for the whole cohort was 86.5%and 86.9%,respectively.After a 52-month of median follow-up,a significant difference was found in IDFS between of the IHC3 pLR and the pHR groups(P=0.001)but not in the IDFS between the low-and high-recurrence risk groups according to the Surexam®21-gene RS and the TAILORx clinical trial criteria(P=0.556)or 21-gene binary RS group(P=0.511).Conclusions:The proposed IHC3 model could reliably predict low and high recurrence risks in most HR-positive EBC patients.This easy-to-use predictive model may be a reliable replacement for the 21-gene genomic assay in patients with EBC who have no access to or cannot afford the 21-gene genomic assay.
