title: Clinical nomogram to predict bone-only metastasis in patients with early breast carcinoma.
abstract: BACKGROUND
  Bone is one of the most common sites of distant metastasis in breast cancer. The purpose of this study was to combine selected clinical and pathologic variables to develop a nomogram that can predict the likelihood of bone-only metastasis (BOM) as the first site of recurrence in patients with early breast cancer.
  
  
  METHODS
  Medical records of patients with non-metastatic breast cancer were retrospectively collected. On the basis of the analysis of patient and tumour characteristics using the Cox proportional hazards regression model, a nomogram to predict BOM was constructed for a 4175-patient-training cohort. The nomogram was validated in an independent cohort of 579 patients.
  
  
  RESULTS
  Among 4175 patients with non-metastatic breast cancer, 314 developed subsequent BOM. Age, T classification, lymph node status, lymphovascular space invasion, and hormone receptor status were significantly and independently associated with subsequent BOM. The nomogram had a concordance index of 0.69 in the training set and 0.73 in the validation set.
  
  
  CONCLUSIONS
  We have developed a clinical nomogram to predict subsequent BOM in patients with non-metastatic breast cancer. Selection of a patient population at high risk for BOM could facilitate research of more specific staging approaches or the selective use of bone-targeted therapy.
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisiere Hospital, AP-HP, 2 Rue Ambroise-Pare, Paris, France.|University Denis Diderot, Paris, France.|Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Yann
authors.initials: Y
authors.lastname: Delpech
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Sami I
authors.initials: SI
authors.lastname: Bashour
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisiere Hospital, AP-HP, 2 Rue Ambroise-Pare, Paris, France.|University Denis Diderot, Paris, France.
authors.forename: Ruben
authors.initials: R
authors.lastname: Lousquy
authors.affiliation: Department of Surgery, Institut Curie, Saint-Cloud, Paris, France.|Department of Gynecology and Obstetrics, Tenon Hospital, Paris, France.|University Pierre and Marie Curie, Paris, France.|Versailles Saint-Quentin-en-Yvelines University, Versailles, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hess
authors.affiliation: Department of Surgical Oncology, Georges Francois Leclerc Cancer Center, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisiere Hospital, AP-HP, 2 Rue Ambroise-Pare, Paris, France.|University Denis Diderot, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.affiliation: Breast Medical Oncology Program, NYU Cancer Institute, New York, NY, USA.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Esteva
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Noato T
authors.initials: NT
authors.lastname: Ueno
authors.affiliation: Section of Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Lajos
authors.initials: L
authors.lastname: Pusztai
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Nuhad K
authors.initials: NK
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000473:pathology / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D049451:Nomograms; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult