title: Clinical predictive models for chemotherapy-induced febrile neutropenia in breast cancer patients: a validation study.
abstract: BACKGROUND
  Predictive models for febrile neutropenia (FN) would be informative for physicians in clinical decision making. This study aims to validate a predictive model (Jenkin's model) that comprises pretreatment hematological parameters in early-stage breast cancer patients.
  
  
  METHODS
  A total of 428 breast cancer patients who received neoadjuvant/adjuvant chemotherapy without any prophylactic use of colony-stimulating factor were included. Pretreatment absolute neutrophil counts (ANC) and absolute lymphocyte counts (ALC) were used by the Jenkin's model to assess the risk of FN. In addition, we modified the threshold of Jenkin's model and generated Model-A and B. We also developed Model-C by incorporating the absolute monocyte count (AMC) as a predictor into Model-A. The rates of FN in the 1st chemotherapy cycle were calculated. A valid model should be able to significantly identify high-risk subgroup of patients with FN rate >20%.
  
  
  RESULTS
  Jenkin's model (Predicted as high-risk when ANC≦3.1*10^9/L;ALC≦1.5*10^9/L) did not identify any subgroups with significantly high risk (>20%) of FN in our population, even if we used different thresholds in Model-A(ANC≦4.4*10^9/L;ALC≦2.1*10^9/L) or B(ANC≦3.8*10^9/L;ALC≦1.8*10^9/L). However, with AMC added as an additional predictor, Model-C(ANC≦4.4*10^9/L;ALC≦2.1*10^9/L; AMC≦0.28*10^9/L) identified a subgroup of patients with a significantly high risk of FN (23.1%).
  
  
  CONCLUSIONS
  In our population, Jenkin's model, cannot accurately identify patients with a significant risk of FN. The threshold should be changed and the AMC should be incorporated as a predictor, to have excellent predictive ability.
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Xiaolan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Heran
authors.initials: H
authors.lastname: Deng
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Liling
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Fengxi
authors.initials: F
authors.lastname: Su
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Weijuan
authors.initials: W
authors.lastname: Jia
authors.affiliation: Department of Pediatric Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
authors.forename: Xiaogeng
authors.initials: X
authors.lastname: Deng
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001772:Blood Cell Count; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003520:Cyclophosphamide