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Purpose The ability to accurately predict the likelihood of achieving breast conservation surgery (BCS)after neoadjuvant chemotherapy (NCT) is important in deciding whether NCT or surgeryshould be the first-line treatment in patients with operable breast cancers. Materials and MethodsWe reviewed the data of 513 women, who had stage II or III breast cancer and receivedNCT and surgery from a single institution. The ability of various clinicopathologic factors topredict the achievement of BCS and tumor size reduction to 3 cm was assessed. Nomograms were built and validated in an independent cohort. ResultsBCS was performed in 50.1% of patients, with 42.2% of tumors reduced to 3 cm afterNCT. A multivariate logistic regression analysis showed that smaller initial tumor size, longerdistance between the lesion and the nipple, absence of suspicious calcifications onmammography, and a single tumor were associated with BCS rather than mastectomy(p < 0.05). Negative estrogen receptor, smaller initial tumor size, higher Ki-67 level, andabsence of in situ component were associated with residual tumor size 3 cm (p < 0.05). Two nomograms were developed using these factors. The areas under the receiver operatingcharacteristic curves for nomograms predicting BCS and residual tumor 3 cm were0.800 and 0.777, respectively. The calibration plots showed good agreement between thepredicted and actual probabilities. ConclusionWe have established a model with novel factors that predicts BCS and residual tumor sizeafter NCT. This model can help in making treatment decisions for patients who are candidatesfor NCT.
