scholarly journals A Scoring System to Predict Arm Lymphedema Risk for Individual Chinese Breast Cancer Patients

Breast Care ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Ling Wang ◽  
Hui-Ping Li ◽  
An-Nuo Liu ◽  
De-Bin Wang ◽  
Ya-Juan Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Scoring System ◽  
Prognostic Score ◽  
Risk Scores ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Total Risk ◽  
Internal Validation

Background: Lymphedema (LE) is recognized as a common complication after axillary lymph node dissection (ALND). Numerous studies have attempted to identify risk factors for LE. However, it is difficult to predict the probability of LE for an individual patient. The purpose of this study was to construct a scoring system for predicting the probability of LE after ALND for Chinese breast cancer patients. Patients and Methods: 358 breast cancer patients were surveyed and followed for 12 months. LE was defined by circumferential measurement. Univariate and multivariate logistic regression analyses were used to screen risk factors of LE. Based on this, ß-coefficient of each risk factor was translated into a prognostic score and the scoring system was constructed. The area under the receiver operating characteristic curve (AUC) and calibration were calculated as an index for the predictive value of the scoring system. The model was internally validated using bootstrapping techniques. Results: The incidence rate of LE was 31.84%. Variables associated with LE and their corresponding score in the scoring system were: the level of ALND (level I = 0, level II = 1, level III = 2), history of hypertension (yes = 1, no = 0), surgery on dominant arm (yes = 1, no = 0), radiotherapy (yes = 2, no = 0), and surgical infection/seroma/early edema (yes = 2, no = 0). The probability of LE was predicted according to the total risk scores. The system had good discrimination, with an AUC at 0.877. If a cut-off value of 3 was used, the sensitivity was 81.20% and the specificity was 80.90%. An individual whose total risk score was higher than 3 was recognized as being at risk for LE. On internal validation, the bootstrap-corrected predictive accuracy was 0.798. The model demonstrated excellent calibration in the development set and internal validation. Conclusions: Our scoring system could be a simple and easy tool for physicians to estimate the risk of LE.

Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection

Breast Cancer ◽  
2019 ◽  
Vol 27 (2) ◽  
pp. 284-290 ◽  
Author(s):  
Yoshiteru Akezaki ◽  
Eiji Nakata ◽  
Masato Kikuuchi ◽  
Ritsuko Tominaga ◽  
Hideaki Kurokawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Dissection

Nomogram for predicting axillary lymph node pathological complete response in node-positive breast cancer patients after neoadjuvant chemotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12090-e12090
Author(s):  
Wenyan Wang ◽  
Xin Wang ◽  
Xiang Wang ◽  
Jiaqi Liu ◽  
Pin Zhang
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Complete Response ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Internal Validation ◽  
Node Positive ◽  
Positive Breast Cancer

e12090 Background: Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. Our goal is to develop a new predictive clinical model to assess the axillary lymph node pCR rate after NAC. Methods: A retrospective series of 547 patients who had biopsy-proven positive ALNs at diagnosis and undergoing axillary lymph node dissection from 2007 to 2014 in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features and developed a nomogram to predict the probability of ALN pCR. Univariate assessment was performed using a logistic regression model. A multivariate logistic regression stepwise model was used to generate a nomogram to predict ALN pCR in node positive patients Variables with P < 0.05 on multivariable analysis were included in the nomogram. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was estimated using 50-50 hold out validation method. Nomogram was validated externally with the prospective cohort of 167 patients from 2016 to 2018. Results: In retrospective study, there were 172 (31.4%) patients achieved axillary pCR after NAC. Multivariate analysis indicated that clinical nodal (N) stage, hormone receptor (HR) status and clinical response of primary tumor after NAC were significant independent predictors for axillary pCR ( P< 0.05). The NAC nomogram was based on these three variables. In the internal validation of performance, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in an external cohort with an AUC of 0.734. Conclusions: We developed a nomogram to predict the likelihood of axillary pCR in node positive breast cancer patients after NAC. The predictive model performed well in prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALND after NAC.

scholarly journals Risk factors for axillary lymph node metastases in clinical stage T1-2N0M0 breast cancer patients

Medicine ◽  
2019 ◽  
Vol 98 (40) ◽  
pp. e17481 ◽  
Author(s):  
Yuanxin Zhang ◽  
Ji Li ◽  
Yuan Fan ◽  
Xiaomin Li ◽  
Juanjuan Qiu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Axillary Lymph Node Metastases ◽  
Node Metastases ◽  
Stage T1

scholarly journals Frequency of Brain Metastasis in Breast Cancer Patients and Factors Leading to it

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Cancer Patients ◽  
Tumor Size ◽  
Triple Negative ◽  
Univariate Analysis ◽  
Axillary Lymph ◽  
Breast Cancer Patients

Objective: Breast cancer is the second commonest cause of brain metastasis after lung cancer.10-16% of patients diagnosed with breast cancer ultimately develop brain metastasis. As most of chemotherapeutic drugs do not cross blood brain barrier despite adequate management of breast cancer risk of CNS relapse persist. Prognosis for breast cancer patients after developing brain metastases is poor. Therefore, we sought to determine the frequency of brain metastasis in Pakistani breast cancer survivors, how often brain metastasis is the first site of recurrence and what are the risk factors that indicate greater likelihood of this event occurrence so that more accurate screening for patients at risk can be established. Methods: We retrospectively reviewed medical record of 507 patients with invasive breast cancer of all stages who received treatment in Liaquat National Hospital from January 2010 to December 2015. Patients who developed brain metastasis were identified and stratified according to risk factors. Result: Out of 507 patients 51(10%) developed brain metastasis. 14 patients had brain metastasis as first site of recurrence. On univariate analysis negative hormone receptor status, triple negative and her2 enriched subtype, higher tumor size, lymph node positivity, stages 3 and 4, lymphovascular and peri nodal extension, shorter diseasefree survival and recurrence with visceral metastasis had a statistically highly significant impact on brain metastasis occurrence, while young age at diagnosis (≤35 years), menopausal status, BMI and tumor histology showed no statistically significant impact. Conclusion: Brain metastases are more frequent in triple negative, Her2Neu positive and Estrogen and Progesterone receptor negative patients. Other factors associated with higher risk of brain metastases in breast cancer patients include larger tumor size, positive axillary lymph nodes, higher stage and lymphovascular and periodontal invasion. Frequency of brain metastasis in breast cancer patients and factors leading to it.

scholarly journals Incidence and Risk Factors of Arm Lymphedema Following Breast Cancer Treatment

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 213s-213s
Author(s):  
M. Owusu Sekyere
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node Dissection ◽  
Late Stage ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Dissection

Background: All breast cancer patients are at risk for developing lymphedema (LE) as a complication of breast cancer surgery and radiation. The reported incidence ranges from 5%-60%. In Ghana, 50% of women with breast cancer who come to the hospital present with late-stage breast cancer. Komfo Anokye Teaching Hospital (KATH) has no available data to support LE incidence. Aim: To determine the incidence and risk factors of lymphedema after breast cancer treatment at the oncology unit of KATH, Kumasi, Ghana between 01 January 2005 to 31 December 2008. Methods: Breast cancer and lymphedema related variables were collected from the medical records of breast cancer patients. Data were analyzed using descriptive statistics and χ2 tests. Results: Among 313 patients treated for breast cancer between 2005 and 2008, 31 (9.9%) developed lymphedema after treatment. A χ2 test showed that axillary lymph node dissection was statistically a significant risk factor of lymphedema (χ2 test value = 7.055, P = 0.008). Radiation and late stage of breast cancer diagnosis may have contributed in development of lymphedema despite having P value > 0.05. Age, BMI and hypertension were also not associated with lymphedema. Conclusion: This study provides evidence that the incidence of lymphedema was 9.9% with axillary lymph node dissection as a statistically significant risk factor of lymphedema. Implication for practice: With majority of breast cancer patients presenting with late stage disease and also undergoing axillary lymph node dissection, lymphedema will continue to be a problem in Ghana. Knowing the incidence and risk factors of lymphedema not only helps in the early detection and effective management of lymphedema but also provides base-line data for further research on lymphedema in Ghana.

scholarly journals Nomogram for predicting axillary lymph node pathological response in node-positive breast cancer patients after neoadjuvant chemotherapy

2021 ◽  
Author(s):  
Wenyan Wang ◽  
Xin Wang ◽  
Xiang Wang ◽  
Pilin Wang
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
External Validation ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Internal Validation ◽  
Node Positive ◽  
Positive Breast Cancer

Abstract Background Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. Our goal is to develop a new predictive clinical model to assess the axillary lymph node pCR rate after NAC. Methods A retrospective series of 547 patients who had biopsy-proven positive ALNs at diagnosis and undergoing axillary lymph node dissection from 2007 to 2014 in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features and developed a nomogram to predict the probability of ALN pCR. Univariate assessment was performed using a logistic regression model. A multivariate logistic regression stepwise model was used to generate a nomogram to predict ALN pCR in node positive patients Variables with P < 0.05 on multivariable analysis were included in the nomogram. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was estimated using 50–50 hold out validation method. Nomogram was validated externally with the prospective cohorts of 167 patients from 2016 to 2018 of Cancer Hospital of Chinese Academy of Medical Sciences and 75 patients from 2018 to 2019 of Beijing Tiantan hospital. Results In retrospective study, there were 172 (31.4%) patients achieved axillary pCR after NAC. Multivariate analysis indicated that clinical nodal (N) stage, estrogen receptor (ER) status and clinical response of primary tumor after NAC were significant independent predictors for axillary pCR (P < 0.05). The NAC nomogram was based on these three variables. In the internal validation of performance, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.862 and 0.766, respectively, which demonstrated good discriminatory power in the external validation data sets. Conclusion We developed a nomogram to predict the likelihood of axillary pCR in node positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALND after NAC.

scholarly journals Candidates of Genomic Tests in HR+/HER2- Breast Cancer Patients With 1-2 Positive Sentinel Lymph Node Without Axillary Lymph Node Dissection: Analysis From Multicentric Cohorts

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhao Bi ◽  
Jia-Jian Chen ◽  
Peng-Chen Liu ◽  
Peng Chen ◽  
Wei-Li Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Internal Validation ◽  
Her2 Breast Cancer ◽  
Positive Slns

BackgroundThe genomic tests such as the MammaPrint and Oncotype DX test are being gradually applied for hormone receptor positive/HER-2 negative (HR+/HER2-) breast cancer patients with up to three positive axillary lymph nodes (ALNs). The first results from RxPONDER trial suggested that Oncotype DX could be applied to patients with 1-2 positive sentinel lymph nodes (SLNs) without axillary lymph node dissection (ALND), which constituted 37.4% of the intent-to-treat population. However, there was no distinctive research on how to apply genomic tests precisely to HR+/HER2- patients with 1-2 positive SLNs without ALND. The purpose was to construct a nomogram using the multi-center retrospective data to predict precisely which HR+/HER2- candidates with 1-2 positive SLNs could be subjected to genomic tests (≤ 3 positive lymph nodes).MethodsWe conducted a retrospective analysis of 18,600 patients with stage I-III breast cancer patients treated with sentinel lymph node biopsy (SLNB) in Shandong Cancer Hospital, Fudan University Shanghai Cancer Center, and West China Hospital. The univariate and multivariate logistic regression analysis was conducted to identify the independent predictive factors of having ≤ 3 positive nodes among patients with 1-2 positive SLNs. A nomogram was developed based on variables in the final model with p&lt;0.05. Calibration of the nomogram was carried out by internal validation using the bootstrap resampling approach and was displayed using a calibration curve. The discrimination of the model was evaluated using the ROC curve.ResultsBased on the database of the three institutions, a total of 18,600 breast cancer patients were identified undergoing SLNB between May 2010 and 2020. Among the 1817 HR+/HER2- patients with 1-2 positive SLNs undergoing ALND, 84.2% harbored ≤ 3 totals metastatic ALNs. The multivariate logistic regression analysis identified imaging abnormal nodes (OR=0.197, 95%CI: 0.082-0.472), the number of positive SLNs (OR=0.351, 95%CI: 0.266-0.464), the number of negative SLNs (OR=1.639, 95%CI: 1.465-1.833), pathological tumor stage (OR=0.730, 95%CI: 0.552-0.964), and lympho-vascular invasion (OR=0.287, 95%CI: 0.222-0.398) as independent predictors for the proportion of patients with ≤ 3 total metastatic ALNs (all p&lt;0.05). These five predictors were used to create a predictive nomogram. The AUC value was 0.804 (95%CI: 0.681-0.812, p&lt;0.001). The calibration curve showed a satisfactory fit between the predictive and actual observation based on internal validation with a bootstrap resampling frequency of 1000.ConclusionThe nomogram based on the multi-centric database showed a good accuracy and could assist the oncologist in determining precisely which HR+/HER2- candidates with 1-2 positive SLNs without ALND could perform genomic tests. In the era of SLNB and precision medicine, the combined application of genomic tests and SLNB could provide patients with a better strategy of dual de-escalation management, including the de-escalation of both surgery and systemic treatment.

Sign in / Sign up

Export Citation Format

Share Document