Validation of the Memorial Sloan Kettering Cancer Center nomogram for predicting non-sentinel lymph node metastasis in sentinel lymph node-positive breast-cancer patients.
BACKGROUND
The main purpose of the study reported here was to validate the clinical value of the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram that predicts non-sentinel lymph node (SLN) metastasis in SLN-positive patients with breast cancer.


METHODS
Data on 1,576 patients who received sentinel lymph node biopsy (SLNB) at the Shandong Cancer Hospital from December 2001 to March 2014 were collected in this study, and data on 509 patients with positive SLN were analyzed to evaluate the risk factors for non-SLN metastasis. The MSKCC nomogram was used to estimate the probability of non-SLN metastasis and was compared with actual probability after grouping into deciles. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve.


RESULTS
Tumor size, histological grade, lymphovascular invasion, multifocality, number of positive SLNs, and number of negative SLNs were correlated with non-SLN metastasis (P<0.05) by univariate analysis. However, multivariate analysis showed that tumor size (P=0.039), histological grade (P=0.043), lymphovascular invasion (P=0.001), number of positive SLNs (P=0.001), and number of negative SLNs (P=0.000) were identified as independent predictors for non-SLN metastasis. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.722. Patients with predictive values lower than 10% (97/492, 19.7%) had a frequency of non-SLN metastasis of 17.5% (17/97).


CONCLUSIONS
The MSKCC nomogram can provide an accurate prediction of the probability of non-SLN metastasis, and offers a reference basis about axillary lymph node dissection. Axillary lymph node dissection could be avoided in patients with predictive values lower than 10%.
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, People's Republic of China.
Xiang
X
Bi
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Yongsheng
Y
Wang
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, People's Republic of China.
Minmin
M
Li
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Peng
P
Chen
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Zhengbo
Z
Zhou
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Yanbing
Y
Liu
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Tong
T
Zhao
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Zhaopeng
Z
Zhang
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Chunjian
C
Wang
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Xiao
X
Sun
Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China.
Pengfei
P
Qiu
MSKCC nomogram; SLN; axillary lymph node dissection; probability; risk factors