Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Prediction of Tumor Progression During Neoadjuvant Chemotherapy and Survival Outcome in Patients With Triple-Negative Breast Cancer

  • Heera Yoen (Department of Radiology, Seoul National University Hospital) ;
  • Soo-Yeon Kim (Department of Radiology, Seoul National University Hospital) ;
  • Dae-Won Lee (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han-Byoel Lee (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Nariya Cho (Department of Radiology, Seoul National University Hospital)
  • Received : 2022.12.07
  • Accepted : 2023.05.01
  • Published : 2023.07.01
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Abstract

Objective: To investigate the association of clinical, pathologic, and magnetic resonance imaging (MRI) variables with progressive disease (PD) during neoadjuvant chemotherapy (NAC) and distant metastasis-free survival (DMFS) in patients with triple-negative breast cancer (TNBC). Materials and Methods: This single-center retrospective study included 252 women with TNBC who underwent NAC between 2010 and 2019. Clinical, pathologic, and treatment data were collected. Two radiologists analyzed the pre-NAC MRI. After random allocation to the development and validation sets in a 2:1 ratio, we developed models to predict PD and DMFS using logistic regression and Cox proportional hazard regression, respectively, and validated them. Results: Among the 252 patients (age, 48.3 ± 10.7 years; 168 in the development set; 84 in the validation set), PD was occurred in 17 patients and 9 patients in the development and validation sets, respectively. In the clinical-pathologic-MRI model, the metaplastic histology (odds ratio [OR], 8.0; P = 0.032), Ki-67 index (OR, 1.02; P = 0.044), and subcutaneous edema (OR, 30.6; P = 0.004) were independently associated with PD in the development set. The clinical-pathologic-MRI model showed a higher area under the receiver-operating characteristic curve (AUC) than the clinical-pathologic model (AUC: 0.69 vs. 0.54; P = 0.017) for predicting PD in the validation set. Distant metastases occurred in 49 patients and 18 patients in the development and validation sets, respectively. Residual disease in both the breast and lymph nodes (hazard ratio [HR], 6.0; P = 0.005) and the presence of lymphovascular invasion (HR, 3.3; P < 0.001) were independently associated with DMFS. The model consisting of these pathologic variables showed a Harrell's C-index of 0.86 in the validation set. Conclusion: The clinical-pathologic-MRI model, which considered subcutaneous edema observed using MRI, performed better than the clinical-pathologic model for predicting PD. However, MRI did not independently contribute to the prediction of DMFS.

Keywords

Acknowledgement

The statistical analyses were supported by the Medical Research Collaborating Center (MRCC) of Seoul National University. We sincerely thank Professor Yunhee Choi of MRCC for her statistical assistance and consultation.

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