title: A Nomogram to Predict the Benefit of Radiation Therapy After Breast-Conserving Surgery in Elderly Patients with Stage I & ER-Negative, or Stage II/III Disease.
abstract: BACKGROUND
  Radiotherapy (RT) may be omitted for elderly (age >70 years) breast cancer patients with favorable disease [stage I and estrogen receptor (ER)-positive with endocrine therapy]. This study sought to develop a nomogram to predict the survival benefit of RT in elderly patients with stage I & ER-negative or stage II/III (regardless of ER status) disease.
  
  
  METHODS
  We used surveillance, epidemiology and end results data to identify 9,079 patients (age ≥70 years) with stage I & ER-negative or stage II/III (regardless of ER status) disease who received breast-conserving surgery between 1990 and 2005. Cancer-specific survival (CSS) was estimated using Kaplan-Meier analysis. Competing-risk regression was used to determine the effect of predictors on CSS. A nomogram was then developed and validated using bootstrapped technique.
  
  
  RESULTS
  With a median follow-up of 83 months, the overall 10- and 15-year CSS were 82.1 and 75.8 %, respectively. RT was significantly associated with improved CSS in the multivariate analysis. A nomogram was developed for the prediction of 10-year CSS and showed a bootstrapped-corrected area under the curve value of 0.679. RT did not deliver any survival benefit to patients with predicted CSS >90 %. In addition, RT significantly increased the 10-year CSS by 3.6 and 10.1 % in patients with predicted CSS from 0.80 to 0.90 and <0.80, respectively.
  
  
  CONCLUSIONS
  This nomogram is a useful tool to predict the 10-year CSS in patients with stage I and ER-negative or stage II/III (regardless of ER status) disease. The benefit of RT varied among patients with different predicted CSS.
authors: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.|Departments of Surgery and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Kai
authors: K
authors: Chen
authors: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. fengxisu@vip.163.com.
authors: Fengxi
authors: F
authors: Su
authors: Departments of Surgery and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. ljacob14@jhmi.edu.
authors: Lisa K
authors: LK
authors: Jacobs
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D049451:Nomograms; D012372:ROC Curve; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen / Q000032:analysis; D018426:SEER Program; D015996:Survival Rate
chemical_list: D011960:Receptors, Estrogen