Post-operative nomogram for predicting freedom from recurrence after surgery in localised breast cancer receiving adjuvant hormone therapy

A scoring system to predict recurrence in breast cancer patients

OBJECTIVE

Current breast cancer recurrence prediction models have limitations for clinical practice (statistical methodology, simplicity and specific populations). We therefore developed a new model that overcomes these limitations.

METHODS

This cohort study comprised 272 patients with breast cancer followed between 2003 and 2016. The main variable was time-to-recurrence (locoregional and/or metastasis) and secondary variables were its risk factors: age, postmenopause, grade, oestrogen receptor, progesterone receptor, c-erbB2 status, stage, multicentricity, diagnosis and treatment. A Cox model to predict recurrence was estimated with the secondary variables, and this was adapted to a points system to predict risk at 5 and 10 years from diagnosis. The model was validated internally by bootstrapping, calculating the C statistic and smooth calibration (splines). The system was integrated into a mobile application for Android.

RESULTS

Of the 272 patients with breast cancer, 47 (17.3%) developed recurrence in a mean time of 8.6 ± 3.5 years. The system variables were: age, grade, multicentricity and stage. Validation by bootstrapping showed good discrimination and calibration.

CONCLUSIONS

A points system has been developed to predict breast cancer recurrence at 5 and 10 years.

Surgical resection versus liver transplantation for hepatocellular carcinoma within the Hangzhou criteria: a preoperative nomogram-guided treatment strategy

BACKGROUND

With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference.

METHODS

From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients.

RESULTS

The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P<0.001). The high-risk SR group was associated with a worse recurrence-free survival rate but similar overall survival rate compared with the transplantation group (3-year recurrence-free survival rate, 35.9% vs 74.1%, P<0.001; 3-year overall survival rate, 78.9% vs 79.6%, P>0.05).

CONCLUSIONS

This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high-risk patients.