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A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy

  • Lim, Yu Jin (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Lee, Sea-Won (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Choi, Noorie (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Kwon, Jeanny (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Eom, Keun-Yong (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Kang, Eunyoung (Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine) ;
  • Kim, Eun-Kyu (Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine) ;
  • Kim, Jee Hyun (Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine) ;
  • Kim, Yu Jung (Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine) ;
  • Kim, Se Hyun (Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine) ;
  • Park, So Yeon (Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine) ;
  • Kim, In Ah (Department of Radiation Oncology, Seoul National University Bundang Hospital)
  • Received : 2017.10.24
  • Accepted : 2017.12.05
  • Published : 2018.10.15

Abstract

Purpose This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer. Materials and Methods A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model. Results The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (${\geq}45years$ vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029). Conclusion The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.

Acknowledgement

Supported by : Korean Ministry of Science and Information & Communication Technology

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