Abstract
Background: The purpose of this study was to evaluate the factors associated with achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) in estrogen receptor-positive(ER+) breast cancer patients, and develop a nomogram that predict the probability of achieving pCR after NACT in ER+ breast cancer patients.Methods: A total of 431 ER+ breast cancer patients who received four cycles of thrice-weekly standard NACT and subsequently underwent surgery in the first affiliated hospital of Chongqing medical university were retrospectively enrolled, and data on their pretreatment clinicopathologic features and multiple laboratory indexes were collected. The optimal cut-off values of age, NLR, PLR and FBG were determined by the Youden index. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Forward stepwise multivariable logistic regression analysis was applied to identify predictive factors for achieving pCR after NACT. A nomogram was then developed according to the logistic model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, receiver operating characteristic curve, calibration plot, and decision curve analysis.Results: pCR was achieved in 59 (13.7%) patients after NACT. Multivariate analysis identified four independent factors, including tumor size, ER expression, Ki67 index and histological grade. The nomogram established based on these factors showed its discriminatory ability, with the area under the curve (AUC) of 0.774 (95% confidence interval 0.708–0.841) and the C-index was 0.809 (95% CI: 0.751–0.867). The calibration curve showed that the predictive ability of the nomogram was a good fit to actual observation. The decision curve showed that if the threshold is 13% and 65%, using this nomogram can obtain more benefit.Conclusions: The nomogram exhibited a sufficient discriminatory ability for predicting pCR of NACT in ER+ breast cancer patients.
GSTM1 polymorphism in Oncotype DX assay is a potential predictive factor for taxane-based neoadjuvant chemotherapy in estrogen receptor-positive Chinese breast cancer patients
