A Nomogram For Predicting The Pathological Complete Remission Of Axillary Lymph Node In Breast Cancer Patients After Neoadjuvant Chemotherapy

Background Breast cancer is one of the most common women health killers worldwide.Its most common route of metastasis is through lymph node.At present,local treatment for axillary lymph node metastasis is mainly based on axillary lymph node dissection with assisted postoperative radiotherapy.It is believed that surgery is not the best option for patients who are diagnosed as locally advanced breast cancer and the current mainstream treatment is to undergo neoadjuvant chemotherapy.After the tumor and lymph nodes are narrowed,surgery will be the next step.For patients with breast cancer who are node-negative before chemotherapy,sentinel lymph node biopsy can be used instead of axillary lymph node dissection.For patients with breast cancer who are node-positive before and after chemotherapy,direct axillary lymph node dissection will be performed.But it will be difficult to evaluate the status of axillary lymph nodes accurately for patients who are node-positive and turn into node-negative after neoadjuvant chemotherapy.On one hand,lymphatic reflux may be affected after neoadjuvant chemotherapy,which may result in a decrease in the detection rate and accuracy of sentinel lymph nodes.On the other hand,the structure of the armpits will also change due to the inflammatory response caused by chemotherapy.Accurate assessment of axillary lymph node status after neoadjuvant chemotherapy is significant in the breast cancer treatment.It not only affects the management of the risk of local recurrence and the approach of breast reconstruction surgery,but also affects the comprehensive treatments after surgery.Therefore,the establishment of a reliable preoperative axillary lymph node status evaluation system is an important part of axillary lymph node management and a key part of surgical treatment.Objective: To develop and validate a nomogram to predict the pathological complete remission of axillary lymph node in breast cancer patients after neoadjuvant chemotherapy preoperatively.Methods: A total of 120 eligible breast cancer patients who received neoadjuvant chemotherapy were divided into a training set(n=80)and a validation set(n=40).Clinical,imaging and pathological features were extracted from hospitalization information of each patient.Combined with independent predict factors,a nomogram was built with a multivariate logistic regression model.Nomogram performance was assessed in the training set and validated in the validation set.Finally,decision curve analysis was performed with the combined training and validation set to estimate the clinical usefulness of the nomogram.Results: The nomogram,consisting of four ALN status–related features,achieved favorable prediction efficacy.The nomogram,which incorporated those four signatures,also showed good calibration and discrimination in the training set [AUC 0.895;95% confidence interval(CI),0.829–0.961] and the validation set(AUC 0.896;95% CI 0.777–1.000).The decision curve indicated the clinical usefulness of our nomogram.Conclusion: The presented nomogram is a kind of noninvasive preoperative prediction tool that incorporates the clinical signature and pathologic status.Our study find that histological grade,the status of HER-2,chemotherapy response and vascular tumor thrombus are independent predictors of p CR in axillary lymph nodes.Our nomogram shows favorable predictive accuracy for ALN Pathological Complete Remission in patients with breast cancer after NAC.