title: A new model for predicting non-sentinel lymph node status in Chinese sentinel lymph node positive breast cancer patients.
abstract: BACKGROUND
  Our goal is to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stanford Online Calculator (SOC) for predicting non-sentinel lymph node (NSLN) metastasis in Chinese patients, and develop a new model for better prediction of NSLN metastasis.
  
  
  METHODS
  The MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients. Univariate and multivariate analyses were performed to evaluate the relationship between NSLN metastasis and clinicopathologic factors, using the medical records of the first 80 breast cancer patients. A new model predicting NSLN metastasis was developed from the 80 patients.
  
  
  RESULTS
  The MSKCC and SOC predicted NSLN metastasis in a series of 120 patients with an area under the receiver operating characteristic curve (AUC) of 0.688 and 0.734, respectively. For predicted probability cut-off points of 10%, the false-negative (FN) rates of MSKCC and SOC were both 4.4%, and the negative predictive value (NPV) 75.0% and 90.0%, respectively. Tumor size, Kiss-1 expression in positive SLN and size of SLN metastasis were independently associated with NSLN metastasis (p<0.05). A new model (Peking University People's Hospital, PKUPH) was developed using these three variables. The MSKCC, SOC and PKUPH predicted NSLN metastasis in the second 40 patients from the 120 patients with an AUC of 0.624, 0.679 and 0.795, respectively.
  
  
  CONCLUSIONS
  MSKCC nomogram and SOC did not perform as well as their original researches in Chinese patients. As a new predictor, Kiss-1 expression in positive SLN correlated independently with NSLN metastasis strongly. PKUPH model achieved higher accuracy than MSKCC and SOC in predicting NSLN metastasis in Chinese patients.
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Miao
authors.initials: M
authors.lastname: Liu
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Wang
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Pan
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Deqi
authors.initials: D
authors.lastname: Yang
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xie
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Jiajia
authors.initials: J
authors.lastname: Guo
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Jiaqing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Breast Disease Center, Peking University People's Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhou
mesh_terms: D019540:Area Under Curve; D044466:Asian People; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015233:Models, Statistical; D012372:ROC Curve
references.citation: Cancer. 2009 Sep 15;115(18):4064-70
references.pmid: 19517477
references.citation: Br J Surg. 2010 Nov;97(11):1646-52
references.pmid: 20641049
references.citation: Breast Cancer Res Treat. 2005 May;91(2):113-9
references.pmid: 15868438
references.citation: Breast Cancer Res Treat. 2008 Dec;112(3):523-31
references.pmid: 18172758
references.citation: Am J Surg. 2007 Jun;193(6):686-92
references.pmid: 17512277
references.citation: Arch Surg. 2011 Sep;146(9):1035-40
references.pmid: 21931000
references.citation: Breast Cancer Res Treat. 2009 Sep;117(2):409-16
references.pmid: 19153831
references.citation: Cancer Res. 1997 Jun 15;57(12):2384-7
references.pmid: 9192814
references.citation: Ann Surg Oncol. 2001 Mar;8(2):145-9
references.pmid: 11258779
references.citation: Cancer. 2006 Jan 1;106(1):4-16
references.pmid: 16329134
references.citation: Eur J Surg Oncol. 2009 Jul;35(7):690-5
references.pmid: 19046847
references.citation: Ann Surg Oncol. 2003 Apr;10(3):248-54
references.pmid: 12679309
references.citation: Ann Surg Oncol. 2005 Aug;12(8):654-9
references.pmid: 16021535
references.citation: Anticancer Res. 2007 Jul-Aug;27(4B):2499-504
references.pmid: 17695545
references.citation: Arch Surg. 2004 Jun;139(6):648-51
references.pmid: 15197092
references.citation: Cancer. 1989 Jan 1;63(1):181-7
references.pmid: 2910416
references.citation: JAMA. 2011 Feb 9;305(6):569-75
references.pmid: 21304082
references.citation: Br J Surg. 2008 Mar;95(3):302-9
references.pmid: 17876750
references.citation: Breast Cancer Res Treat. 2006 Jan;95(1):1-6
references.pmid: 16322900
references.citation: Lancet. 1997 Jun 28;349(9069):1864-7
references.pmid: 9217757
references.citation: J Cancer Res Clin Oncol. 2005 Mar;131(3):191-8
references.pmid: 15592684
references.citation: Sensors (Basel). 2012;12(7):9936-50
references.pmid: 23012578
references.citation: BMC Cancer. 2008 Mar 04;8:66
references.pmid: 18315887
references.citation: Breast. 2004 Dec;13(6):494-501
references.pmid: 15563857
references.citation: Ann Surg Oncol. 2003 Dec;10(10):1140-51
references.pmid: 14654469
references.citation: Am J Surg. 2002 Mar;183(3):213-7
references.pmid: 11943113
references.citation: Arch Surg. 2001 May;136(5):563-8
references.pmid: 11343548
references.citation: J Clin Oncol. 1997 Jun;15(6):2345-50
references.pmid: 9196149
references.citation: N Engl J Med. 2003 Aug 7;349(6):546-53
references.pmid: 12904519
references.citation: Am Surg. 2004 Feb;70(2):101-5; discussion 105
references.pmid: 15011910
references.citation: Arch Surg. 2001 Sep;136(9):1059-63
references.pmid: 11529831
references.citation: N Engl J Med. 1998 Oct 1;339(14):941-6
references.pmid: 9753708
references.citation: Arch Surg. 2001 Jun;136(6):688-92
references.pmid: 11387010
references.citation: J Biol Chem. 2006 Jan 6;281(1):51-8
references.pmid: 16260418
references.citation: Ann Surg. 1999 Apr;229(4):536-41
references.pmid: 10203087
references.citation: J Natl Cancer Inst. 1996 Dec 4;88(23):1731-7
references.pmid: 8944003
references.citation: Ann Surg Oncol. 2006 Mar;13(3):310-20
references.pmid: 16463073