Validation of Memorial Sloan-Kettering Cancer Center Nomogram to predict the risk of non-sentinel lymph node metastasis in sentinel node positive in Thai breast cancer patients
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Abstract
Background: Complete axillary node dissection (ALND) remains the standard of care for breast cancer with sentinel lymph node (SLN) metastasis. However, 40-70% of patients have no axillary nodes other than the SLN itself, signifying the non-necessity of ALND. To date, Memorial Sloan-Kettering Cancer center (MSKCC) has developed nomogram to predict the risk of non-SLN metastasis. Several validation studies show the accuracy of this nomogram in Western population, but few in Asia and never in Thailand. Objective: Aims of this study were to validate MSKCC nomogram to predict the risk of non-SLN metastasis after SLN positive, and to evaluate the relationship between variability of clinicopathologic factors and non-SLN metastasis. Methods: The MSKCC nomogram was used for calculating the probability of non-SLN metastasis in 92 breast cancer patients at Pramongkutklao Hospital. Multivariate analyses were performed to evaluate the relationship between non-SLN metastases and variable factors. The predictive accuracy was compared with the MSKCC model. A receivers operating characteristics (ROC) curve was plotted, and the area under the curve (AUC) was calculated to access the discriminative power. Results: Additional non-SLN metastases were identified in 52/92 (56%) patients. Presence of LVI, multifocality, and Her-2 positive 3+ were identified as independent predictors for non-SLN status in multivariate analysis. The MSKCC nomogram showed an area under the ROC curve (AUC) value of0.78 (95% CI, 0.688-0.877) after the validation for our collectives. Conclusions: This MSKCC nomogram revealed good validation to predict the risk of non-sentinel lymph node metastasis in sentinel node positive in Thai breast cancer patients.
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2. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003; 349:546-53.
3. Giuliano AE, Haigh PI, Brennan MB, Hansen NM, Kelley MC, Ye W, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol. 2000; 18:2553-9.
4. Turner RR, Ollila DW, Krasne DL, Giuliano AE. Histopathologic validation of the sentinel lymph node hypothesis for breast carcima. Ann Surg. 1997; 226:271-6.
5. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011; 305: 569-75.
6. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer. 2006; 106: 4–16
7. Van Zee KJ, Manasseh DM, Bevilacqua JL, Boolbol SK, Fey JV, Tan LK, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003; 10:1140-51.
8. Kamath VJ, Giuliano R, Dauway EL, Cantor A, Berman C, Ku NN, et al. Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. Arch Surg. 2001;136:688-92.
9. Kuo YL, Chen WC, Yao WJ, Cheng L, Hsu HP, Lai HW, et al. Validation of Memorial Sloan-Kettering Cancer Center nomogram for prediction of non-sentinel lymph node metastasis in sentinel lymph node positive breast cancer patients an international comparison. Int J Surg. 2013; 11:538-43.
10. Chue KM, Yong WS, Thike AA, Ahmed SS, Li HH, Wong CY, et al. Predicting the likelihood of additional lymph node metastasis in sentinel lymph node positive breast cancer: validation of the Memorial Sloan-Kettering Cancer Centre (MSKCC) nomogram. J Clin Pathol. 2014; 67:112-9.
11. Liu M, Wang S, Pan L, Yang D, Xie F, Liu P, et al. A new model for predicting non-sentinel lymph node status in Chinese sentinel lymph node positive breast cancer patients. PLoS One. 2014 ;9(8):e104117.
12. Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, shriver C, et al. The sentinel node in breast cancer-a multicenter validation study. N Engl J Med. 1998;339:941-6
13. Kohrt HE, Olshen RA, Bermas HR, Goodson WH, Wood DJ, Henry S, et al. New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer. 2008 ;8:66.
14. Saidi RF, Dudrick PS, Remine SG, Mittal VK. Non-sentinel lymph node status after positive sentinel lymph node biopsy in early breast cancer. Am Surg.2004; 70: 101–105
15. Klar M, Jochmann A, Foeldi M, Stumpf M, Gitsch G, Stickeler E, et al. The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population. Breast Cancer Res Treat. 2008;112:523-31.
16. Moghaddam Y, Falzon M, Fulford L, Williams NR, Keshtgar MR. Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer. Br J Surg. 2010 ;97:1646-52.
17. Hessman CJ, Naik AM, Kearney NM, Jensen AJ, Diggs BS, Troxell ML, et al. Comparative validation of online nomograms for predicting nonsentinel lymph node status in sentinel lymph node-positive breast cancer. Arch Surg. 2011 ;146:1035-40.
18. Cho J, Han W, Lee JW, Ko E, Kang SY, Jung SY, et al. A scoring system to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a comparison with other scoring systems. Ann Surg Oncol. 2008 ;15:2278-86.
19. Tan EY, Ho B, Chen JJ, Ho PW, Teo C, Earnest A, Chan PM. Predictors of nonsentinel nodal involvement to aid intraoperative decision making in breast cancer patients with positive sentinel lymph nodes. ISRN Oncol. 2011;2011:539503.
20. Sasada T, Murakami S, Kataoka T, Ohara M, Ozaki S, Okada M, et al. Memorial Sloan- Kettering Cancer center Nomogram to predict the risk of non-sentinel node metastasi in Japanese breast cancer patients. Surg Today.2012;42:245-9
21. Lambert LA, Ayers GD, Hwang RF, Hunt KK, Ross MI, Kuerer HM, et al. Validation of a breast cancer nomogram for predicting nonsentinel lymph node metastases after a positive sentinel node biopsy. Ann Surg Oncol. 2006; 13:310-20.
22. Sachdev U, Murphy K, Derzie A, Jaffer S, Bleiweiss IJ, Brower S. Predictors of nonsentinel lymph node metastasis in breast cancer patients. Am J Surg. 2002;183:213-7.