title: Medico-economic impact of MSKCC non-sentinel node prediction nomogram for ER-positive HER2-negative breast cancers.
abstract: BACKGROUND
  Avoiding axillary lymph node dissection (ALND) for invasive breast cancers with isolated tumor cells or micrometastatic sentinel node biopsy (SNB) could decrease morbidity with minimal clinical significance.
  
  
  OBJECTIVE
  The aim of this study is to simulate the medico-economic impact of the routine use of the MSKCC non-sentinel node (NSN) prediction nomogram for ER+ HER2- breast cancer patients.
  
  
  METHODS
  We studied 1036 ER+ HER2- breast cancer patients with a metastatic SNB. All had a complementary ALND. For each patient, we calculated the probability of the NSN positivity using the MSKCC nomogram. After validation of this nomogram in the population, we described how the patients' characteristics spread as the threshold value changed. Then, we performed an economic simulation study to estimate the total cost of caring for patients treated according to the MSKCC predictive nomogram results.
  
  
  RESULTS
  A 0.3 threshold discriminate the type of sentinel node (SN) metastases: 98.8% of patients with pN0(i+) and 91.6% of patients with pN1(mic) had a MSKCC score under 0.3 (false negative rate = 6.4%). If we use the 0.3 threshold for economic simulation, 43% of ALND could be avoided, reducing the costs of caring by 1 051 980 EUROS among the 1036 patients.
  
  
  CONCLUSIONS
  We demonstrated the cost-effectiveness of using the MSKCC NSN prediction nomogram by avoiding ALND for the pN0(i+) or pN1(mic) ER+ HER2- breast cancer patients with a MSKCC score of less than or equal to 0.3.
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.|Translational Research Department, RT2Lab Team, Institut Curie, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Bonsang-Kitzis
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Mouttet-Boizat
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Eugénie
authors.initials: E
authors.lastname: Guillot
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Jean-Guillaume
authors.initials: JG
authors.lastname: Feron
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Fourchotte
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Alran
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Cottu
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Lerebours
authors.affiliation: Department of Clinical Epidemiology, Institut Curie, Paris, France.
authors.forename: Denise
authors.initials: D
authors.lastname: Stevens
authors.affiliation: Department of Tumor Biology, Institut Curie, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Vincent-Salomon
authors.affiliation: Department of Tumor Biology, Institut Curie, Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sigal-Zafrani
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Campana
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.|Translational Research Department, RT2Lab Team, Institut Curie, Paris, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Reyal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000378:metabolism / Q000473:pathology; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D047628:Estrogen Receptor alpha / Q000378:metabolism*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D018803:Models, Economic; D009362:Neoplasm Metastasis; D061206:Neoplasm Micrometastasis / Q000473:pathology*; D049451:Nomograms; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy
chemical_list: D047628:Estrogen Receptor alpha; D018719:Erb-b2 Receptor Tyrosine Kinases; C506487:ESR1 protein, human; C508053:ERBB2 protein, human