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Br J Cancer. 2015 Mar 17;112(6):992-7. doi: 10.1038/bjc.2015.34.

A preoperative nomogram to predict the risk of synchronous distant metastases at diagnosis of primary breast cancer.

Author information

1
Department of Breast and Medical Oncology, Institut Gustave Roussy, Villejuif 94805, France.
2
Department of Surgery, Division of Breast and Plastic Surgery, Institut Gustave Roussy, Villejuif 94805, France.
3
Department of Breast and Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France.
4
Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA.
5
Department of Breast Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.

Abstract

BACKGROUND:

The detection of synchronous metastases at primary diagnosis of breast cancer (BC) affects its initial management. A risk calculator that incorporates many factors to evaluate an individual's risk of harbouring synchronous metastases would be useful to adapt cancer management.

PATIENTS AND METHODS:

Patients with primary diagnosis of BC were identified from three institutional databases sharing homogeneous work-up recommendations. A risk score for synchronous metastases was estimated and a nomogram was constructed using the first database. Its performance was assessed by receiver characteristic (ROC) analysis. The nomogram was externally validated in the two independent cohorts.

RESULTS:

A preoperative nomogram based on the clinical tumour size (P<0.001), clinical nodal status (P<0.001), oestrogen (P=0.17) and progesterone receptors (P=0.04) was developed. The nomogram accuracy was 87.3% (95% confidence interval (CI), 84.45-90.2%). Overall, the area under the ROC curve (AUC) was 86.1% for the validation set from the Institut Curie-René Huguenin, and 63.8% for the MD Anderson validation set. The negative predictive value (NPV) was high in the three cohorts (97-99%).

CONCLUSIONS:

We developed and validated a strong metastasis risk calculator that can evaluate with high accuracy an individual's risk of harbouring synchronous metastases at diagnosis of primary BC.

CONDENSED ABSTRACT:

A nomogram to predict synchronous metastases at diagnosis of breast cancer was developed and externally validated. This tool allows avoiding unnecessary expensive work-up.

PMID:
25668007
PMCID:
PMC4366891
DOI:
10.1038/bjc.2015.34
[Indexed for MEDLINE]
Free PMC Article

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