[Construction of a nomogram prediction model for pathological complete response (pCR) of ipsilateral supraclavicular lymph node after neoadjuvant chemotherapy for breast cancer with first diagnosis of ipsilateral supraclavicular lymph node metastasis].

Objective: To develop a predictive model for pathologic complete response (pCR) of ipsilateral supraclavicular lymph nodes (ISLN) after neoadjuvant chemotherapy for breast cancer and guide the local treatment. Methods: Two hundred and eleven consecutive breast cancer patients with first diagnosis of ipsilateral supraclavicular lymph node metastasis who underwent ipsilateral supraclavicular lymph node dissection and treated in the Breast Department of Henan Cancer Hospital from September 2012 to May 2019 were included. One hundred and forty two cases were divided into the training set while other 69 cases into the validation set. The factors affecting ipsilateral supraclavicular lymph node pCR (ispCR)of breast cancer after neoadjuvant chemotherapy were analyzed by univariate and multivariate logistic regression analyses, and a nomogram prediction model of ispCR was established. Internal and external validation evaluation of the nomogram prediction model were conducted by receiver operating characteristic (ROC) curve analysis and plotting calibration curves. Results: Univariate logistic regression analysis showed that Ki-67 index, number of axillary lymph node metastases, breast pCR, axillary pCR, and ISLN size after neoadjuvant chemotherapy were associated with ispCR of breast cancerafter neoadjuvant chemotherapy (P<0.05). Multivariate logistic regression analysis showed that the number of axillary lymph node metastases (OR=5.035, 95%CI: 1.722-14.721, P=0.003), breast pCR (OR=4.662, 95%CI: 1.456-14.922, P=0.010) and ISLN size after neoadjuvant chemotherapy (OR=4.231, 95%CI: 1.194-14.985, P=0.025) were independent predictors of ispCR of breast cancer after neoadjuvant chemotherapy. A nomogram prediction model of ispCR of breast cancer after neoadjuvant chemotherapy was constructed using five factors: number of axillary lymph node metastases, Ki-67 index, breast pCR, axillary pCR and size of ISLN after neoadjuvant chemotherapy. The areas under the ROC curve for the nomogram prediction model in the training and validation sets were 0.855 and 0.838, respectively, and the difference was not statistically significant (P=0.755). The 3-year disease-free survival rates of patients in the ispCR and non-ispCR groups after neoadjuvant chemotherapy were 64.3% and 54.8%, respectively, with statistically significant differences (P=0.024), the 3-year overall survival rates were 83.8% and 70.2%, respectively, without statistically significant difference (P=0.087). Conclusions: Disease free survival is significantly improved in breast cancer patients with ispCR after neoadjuvant chemotherapy. The constructed nomogram prediction model of ispCR of breast cancer patients after neoadjuvant chemotherapy is well fitted. Application of this prediction model can assist the development of local management strategies for the ipsilateral supraclavicular region after neoadjuvant chemotherapy and predict the long-term prognosis of breast cancer patients.目的： 建立乳腺癌新辅助化疗后同侧锁骨上淋巴结病理完全缓解(ispCR)的预测模型，以指导局部治疗。 方法： 连续纳入2012年9月至2019年5月河南省肿瘤医院收治的首诊同侧锁骨上淋巴结转移且新辅助化疗后行同侧锁骨上淋巴结清扫的乳腺癌患者211例，分为训练集142例，验证集69例。采用单因素和多因素logistic回归分析确定乳腺癌新辅助化疗后ispCR的影响因素，建立乳腺癌新辅助化疗后ispCR的列线图预测模型。通过受试者工作特征(ROC)曲线分析和绘制校准曲线对列线图预测模型进行内部和外部验证评价。 结果： 单因素logistic回归分析显示，Ki-67指数、腋窝淋巴结转移数目、乳腺pCR、腋窝pCR、新辅助化疗后同侧锁骨上淋巴结大小与乳腺癌新辅助化疗后ispCR有关(均P<0.05)。多因素logistic回归分析显示，腋窝淋巴结转移数目(OR＝5.035，95%CI为1.722~14.721)、乳腺pCR (OR＝4.662，95%CI为1.456~14.922)和新辅助化疗后同侧锁骨上淋巴结大小(OR＝4.231，95%CI为1.194~14.985)是乳腺癌新辅助化疗后ispCR的独立影响因素。根据乳腺癌新辅助化疗后ispCR的最佳logistic回归模型，基于腋窝淋巴结转移数目、乳腺pCR、新辅助化疗后同侧锁骨上淋巴结的大小、腋窝pCR、Ki-67指数这5个因素，构建乳腺癌新辅助化疗后ispCR的列线图预测模型。预测模型在训练集和验证集中ROC曲线下的面积分别为0.855和0.838，二者之间差异无统计学意义(P＝0.755)。新辅助化疗后ispCR组和非ispCR组患者的3年无病生存率分别为64.3%和54.8%，差异有统计学意义(P＝0.024)；3年总生存率分别为83.8%和70.2%，差异无统计学意义(P＝0.087)。 结论： 新辅助化疗后ispCR的乳腺癌患者无病生存明显改善。所构建的乳腺癌患者新辅助化疗后ispCR列线图预测模型拟合良好，利用该预测模型可以辅助制定乳腺癌新辅助化疗后同侧锁骨上区的局部处理策略，并预测患者的远期预后。.