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Validation of a nomogram in the prediction of local recurrence risks after conserving surgery for Asian women with ductal carcinoma in situ of the breast

机译:诺模图在亚洲乳腺导管原位癌妇女保守手术后局部复发风险预测中的有效性

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Aims: At our centre, ductal carcinoma in situ (DCIS) was commonly treated with breast-conservation therapy (BCT). Local recurrence after BCT is a major concern. The aims of our study were to review the outcomes of DCIS treatment in our patients and to evaluate a nomogram from Memorial Sloan Kettering Cancer Centre (MSKCC) for predicting ipsilateral breast tumour recurrence (IBTR) in our Asian population. Materials and methods: Chart reviews of 716 patients with pure DCIS treated from 1992 to 2011 were carried out. Univariable Cox regression analyses were used to evaluate the effects of the 10 prognostic factors of the MSKCC nomogram on IBTR. We constructed a separate National Cancer Centre Singapore (NCCS) nomogram based on multivariable Cox regression via reduced model selection by applying the stopping rule of Akaike's information criterion to predict IBTR-free survival. The abilities of the NCCS nomogram and the MSKCC nomogram to predict IBTR of individual patients were evaluated with bootstrapping of 200 sets of resamples and the NCCS dataset, respectively. Harrell's c-index was calculated for each nomogram to evaluate the concordance between predicted and observed responses of individual subjects. Results: Study patients were followed up for a median of 70 months. Over 95% of patients received adjuvant radiotherapy. The 5 and 10 year actuarial IBTR-free survival rates for the cohort were 95.5 and 92.6%, respectively. In the multivariate analysis, independent prognostic factors for IBTR included use of adjuvant endocrine therapy, presence of comedonecrosis and younger age at diagnosis. These factors formed the basis of the NCCS nomogram, which had a similar c-index (NCCS: 0.696; MSKCC: 0.673) compared with the MSKCC nomogram. Conclusion: The MSKCC nomogram was validated in an Asian population. A simpler NCCS nomogram using a different combination of fewer prognostic factors may be sufficient for the prediction of IBTR in Asians, but requires external validation to compare for relative performance.
机译:目的:在我们中心,通常采用保乳疗法(BCT)治疗导管原位癌(DCIS)。 BCT后的局部复发是一个主要问题。我们研究的目的是回顾我们患者中DCIS治疗的结果,并评估纪念斯隆·凯特琳癌症中心(MSKCC)的诺模图,以预测亚洲人群的同侧乳腺肿瘤复发(IBTR)。材料和方法:回顾性分析了1992年至2011年治疗的716例纯DCIS患者。使用单变量Cox回归分析来评估MSKCC诺模图的10个预后因素对IBTR的影响。我们通过应用Akaike信息准则的停止规则来预测无IBTR生存率,通过减少模型选择,通过多变量Cox回归构建了单独的新加坡国家癌症中心(NCCS)列线图。通过分别引导200套重采样和NCCS数据集,评估了NCCS诺模图和MSKCC诺模图预测单个患者的IBTR的能力。为每个诺模图计算Harrell的c指数,以评估各个受试者的预测反应与观察反应之间的一致性。结果:对研究患者进行了平均70个月的随访。超过95%的患者接受了辅助放疗。该人群的5年和10年无IBTR精算生存率分别为95.5和92.6%。在多变量分析中,IBTR的独立预后因素包括辅助内分泌治疗的使用,粉刺坏死的存在和诊断时年龄较小。这些因素构成了NCCS诺模图的基础,与MSKCC诺模图相比,它们具有相似的c指数(NCCS:0.696; MSKCC:0.673)。结论:MSKCC列线图已在亚洲人群中得到验证。使用较少的预后因素的不同组合进行的更简单的NCCS诺模图可能足以预测亚洲人的IBTR,但需要进行外部验证以比较相对性能。

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