title: A nomogram for predicting locoregional recurrence in primary breast cancer patients who received breast-conserving surgery after neoadjuvant chemotherapy.
abstract: BACKGROUND
  We sought to develop and validate a predictive model of locoregional recurrence (LRR) in patients who underwent breast-conserving therapy (BCT) after neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  The clinicopathological characteristics of 520 consecutive primary breast cancer patients with residual tumor who underwent BCT after NAC between 2001 and 2008 were evaluated. Predictive variables of LRR were determined using a multivariate Cox proportional hazards model. The model was validated for discrimination and calibration by bootstrap re-sampling.
  
  
  RESULTS
  At a median follow-up period of 51 months, 64 patients (12%) had developed LRR. Clinical stage T3 or T4, lymphovascular invasion, nuclear grade >3, and ≥4 positive lymph nodes metastasis were positively correlated with LRR. The nomogram for predicting LRR developed by using these four-clinicopathologic variables demonstrated high concordance. Patients with score 0-1 derived by the prediction model had significantly low LRR rate compared with patients with score 2 or higher (P < 0.001).
  
  
  CONCLUSIONS
  This nomogram may be useful to predict LRR in primary breast cancer patients who underwent BCT after NAC with high reproducibility. This model is useful to conduct a study-identifying patients who may need an additional treatment to standard adjuvant therapy because of a high probability of LRR.
authors.affiliation: Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Matsuda
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayashi
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ohde
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagata
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kajiura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshida
authors.forename: Koyu
authors.initials: K
authors.lastname: Suzuki
authors.forename: Seigo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tsunoda
authors.forename: Hideko
authors.initials: H
authors.lastname: Yamauchi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D012372:ROC Curve; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil
keywords: breast cancer; breast-conserving therapy; locoregional recurrence; neoadjuvant chemotherapy; nomogram