Journal Article
. 2018 Jun;30(2).
doi: 10.21147/j.issn.1000-9604.2018.02.05.

A nomogram to predict adjuvant chemotherapy recommendation in breast cancer patients with intermediate recurrence score

Feilin Qu 1 Xiaosong Chen 1 Xiaochun Fei 2 Lin Lin 3 Weiqi Gao 1 Yu Zong 1 Jiayi Wu 1 Ou Huang 1 Jianrong He 1 Li Zhu 1 Weiguo Chen 1 Yafen Li 1 Kunwei Shen 1 
  • PMID: 29861607
  •     22 References
  •     2 citations


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 December 2016 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 Youden-derived 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 were 84.4% 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.

Keywords: Intermediate recurrence score; adjuvant chemotherapy recommendation; breast cancer; nomogram; receiver operating characteristic (ROC).

Integrating comparative effectiveness design elements and endpoints into a phase III, randomized clinical trial (SWOG S1007) evaluating oncotypeDX-guided management for women with breast cancer involving lymph nodes.
Scott D Ramsey, William E Barlow, +6 authors, Gabriel N Hortobagyi.
Contemp Clin Trials, 2012 Sep 25; 34(1). PMID: 23000081    Free PMC article.
Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015.
A S Coates, E P Winer, +6 authors, Panel Members.
Ann Oncol, 2015 May 06; 26(8). PMID: 25939896    Free PMC article.
Highly Cited.
Development and clinical utility of a 21-gene recurrence score prognostic assay in patients with early breast cancer treated with tamoxifen.
Soonmyung Paik.
Oncologist, 2007 Jul 03; 12(6). PMID: 17602054
Nomograms in oncology: more than meets the eye.
Vinod P Balachandran, Mithat Gonen, J Joshua Smith, Ronald P DeMatteo.
Lancet Oncol, 2015 Apr 08; 16(4). PMID: 25846097    Free PMC article.
Highly Cited. Review.
Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis.
Zhixue Zheng, Yinan Zhang, +6 authors, Jiafu Ji.
Chin J Cancer Res, 2016 Jan 12; 27(6). PMID: 26752931    Free PMC article.
Targeting adjuvant chemotherapy: a good idea that needs to be proven!
Daniel F Hayes.
J Clin Oncol, 2012 Feb 23; 30(12). PMID: 22355050
Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study.
Mitch Dowsett, Jack Cuzick, +11 authors, Steven Shak.
J Clin Oncol, 2010 Mar 10; 28(11). PMID: 20212256
Highly Cited.
Oncotype DX breast cancer recurrence score can be predicted with a novel nomogram using clinicopathologic data.
Amila Orucevic, John L Bell, Alison P McNabb, Robert E Heidel.
Breast Cancer Res Treat, 2017 Mar 01; 163(1). PMID: 28243897    Free PMC article.
Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013.
A Goldhirsch, E P Winer, +5 authors, Panel members.
Ann Oncol, 2013 Aug 07; 24(9). PMID: 23917950    Free PMC article.
Highly Cited.
Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up.
C W Elston, I O Ellis.
Histopathology, 1991 Nov 01; 19(5). PMID: 1757079
Highly Cited.
70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer.
Fatima Cardoso, Laura J van't Veer, +32 authors, MINDACT Investigators.
N Engl J Med, 2016 Aug 25; 375(8). PMID: 27557300
Highly Cited.
Identifying Educational Needs of the Multidisciplinary Cancer Team in the Treatment of Metastatic Breast Cancer.
Priya Wanchoo, Chris Larrison, +5 authors, Ana-Marija Djordjevic.
J Natl Compr Canc Netw, 2017 Feb 12; 15(2). PMID: 28188190
Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.
Soonmyung Paik, Gong Tang, +11 authors, Norman Wolmark.
J Clin Oncol, 2006 May 25; 24(23). PMID: 16720680
Highly Cited.
A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.
Soonmyung Paik, Steven Shak, +12 authors, Norman Wolmark.
N Engl J Med, 2004 Dec 14; 351(27). PMID: 15591335
Highly Cited.
Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
E R DeLong, D M DeLong, D L Clarke-Pearson.
Biometrics, 1988 Sep 01; 44(3). PMID: 3203132
Highly Cited.
Providing the best care for patients with breast cancer through use of the multidisciplinary team.
Judy C Boughey, Jill Dietz.
Ann Surg Oncol, 2014 Aug 07; 21(10). PMID: 25096387
Risk of recurrence and chemotherapy benefit for patients with node-negative, estrogen receptor-positive breast cancer: recurrence score alone and integrated with pathologic and clinical factors.
Gong Tang, Jack Cuzick, +6 authors, Norman Wolmark.
J Clin Oncol, 2011 Oct 20; 29(33). PMID: 22010013    Free PMC article.
The 21-Gene Recurrence Score Assay for Node-Positive, Early-Stage Breast Cancer and Impact of RxPONDER Trial on Chemotherapy Decision-Making: Have Clinicians Already Decided?
Jagar Jasem, Christine M Fisher, +5 authors, Peter Kabos.
J Natl Compr Canc Netw, 2017 Apr 14; 15(4). PMID: 28404760
Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial.
Kathy S Albain, William E Barlow, +20 authors, Breast Cancer Intergroup of North America.
Lancet Oncol, 2009 Dec 17; 11(1). PMID: 20005174    Free PMC article.
Highly Cited.
Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update.
Antonio C Wolff, M Elizabeth H Hammond, +19 authors, College of American Pathologists.
J Clin Oncol, 2013 Oct 09; 31(31). PMID: 24101045
Highly Cited.
American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer.
M Elizabeth H Hammond, Daniel F Hayes, +29 authors, Antonio C Wolff.
J Clin Oncol, 2010 Apr 21; 28(16). PMID: 20404251    Free PMC article.
Highly Cited. Systematic Review.
Prospective Validation of a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +28 authors, George W Sledge.
N Engl J Med, 2015 Sep 29; 373(21). PMID: 26412349    Free PMC article.
Highly Cited.
Clinicopathological characteristics, adjuvant chemotherapy decision and disease outcome in patients with breast cancer with a 21-gene recurrence score of 26-30.
Jing Yu, Jiayi Wu, +6 authors, Kunwei Shen.
Oncol Lett, 2020 Jul 30; 20(2). PMID: 32724396    Free PMC article.
An Integrated Score and Nomogram Combining Clinical and Immunohistochemistry Factors to Predict High ISUP Grade Clear Cell Renal Cell Carcinoma.
Junlong Wu, Wen-Hao Xu, +3 authors, Ding-Wei Ye.
Front Oncol, 2019 Jan 09; 8. PMID: 30619768    Free PMC article.