A Russian nomogram for assessing the risk of metastatic regional lymph node involvement in patients with breast cancer

Objective. To comparatively analyze the Russian nomogram developed at the Ulyanovsk State University (the UlSUnomogram) and the foreign nomogram developed at the Memorial Sloan-Kettering Cancer Center (the MSKCC nomogram) for accurately predicting metastatic regional lymph node involvement in the same population of patients with breast cancer (BC). Subjects and methods. The study enrolled 420patients with morphologically verified invasive BC who had been treated at the Ulyanovsk Regional Clinical Oncology Dispensary or the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology. At least one metastatic axillary lymph node was diagnosed in 137/420(32.6%) patients. The probability of axillary lymph node metastasis was calculated using the MSKCC nomogram available on the Memorial Sloan-Kettering Cancer Center website (USA) and using the UlSU nomogram. For each nomogram, receiver operating characteristic (ROC) curves were constructed; the integrated assessment of the diagnostic potential of the nomograms was determined by the area under the ROC curve (AUC). Results. Univariate analysis revealed that primary node tumor size (p = 0.001), lymphovascular invasion (p < 0.001), total malignancy score (p <0.001), estrogen receptor status (p = 0.025), and HER2 status (p = 0.032) were statistically significantly associated with metastatic regional lymph node involvement in BC patients. Both nomograms showed moderate prediction abilities: the AUC (95% CI) for the UlSU nomogram was 0.669 (0.6141-0.7239); that for the MSKCC nomogram was 0.694 (0.6405-0.7479); the differences were not statistically significant. Conclusion. The comparative analysis using the MSKCC nomogram has demonstrated that the UlSU nomogram has equal prognostic value and is more convenient to use.

breast cancer, regional lymph nodes, metastases, nomogram