Development of a normal tissue complication probability model for late unfavourable aesthetic outcome after breast-conserving therapy

<p><b>Purpose/Objectives:</b> To develop a normal tissue complication probability (NTCP) model for late unfavourable aesthetic outcome (AO) after breast-conserving therapy.</p> <p><b>Material and Methods:</b> The BCCT.core software evaluated the AO using standardized photographs of patients treated between 2009 and 2014. Dose maps in 2 Gy equivalents were calculated assuming α/β = 3.6 Gy. Uni- and multivariable logistic regression analysis was performed to study the predictive value of clinicopathological and dosimetric variables for unfavourable AO. The Lyman Kutcher Burman (LKB) model was fit to the data with dose modifying factors (dmf). Model performance was assessed with the area under the curve (AUC) of the receiver operating characteristic curve and bootstrap sampling.</p> <p><b>Results:</b> Forty-four of the 121 analysed patients (36%) developed unfavourable AO. In the optimal multivariable logistic regression model, a larger breast volume receiving ≥55 Gy (V55), a seroma and an axillary lymph node dissection (ALND) were independently associated with an unfavourable AO, AUC = 0.75 (95%CI 0.64;0.85). Beta-estimates were −2.68 for β₀, 0.057 for V55, 1.55 for seroma and 1.20 for ALND. The optimal LKB model parameters were EUD_3.6(50) = 63.3 Gy, <i>n</i> = 1.00, m = 0.23, dmf(seroma) = 0.83 and dmf(ALND) = 0.84, AUC = 0.74 (95%CI 0.61;0.83).</p> <p><b>Conclusions:</b> An NTCP model for late unfavourable AO after breast-conserving therapy was developed including seroma, axillary lymphadenectomy and V55.</p

rs11977670, chromosome 7:139942304 G>A, and association ILC in populations of European ancestry.

<p>rs11977670, chromosome 7:139942304 G>A, and association ILC in populations of European ancestry.</p

SNPs associated with ILC (P<5×10⁻⁸) or LCIS (P<0.05) in a pooled lobular analysis (GLACIER and BCAC).

<p>SNPs associated with ILC (P<5×10⁻⁸) or LCIS (P<0.05) in a pooled lobular analysis (GLACIER and BCAC).</p

SNPs showing differential lobular and ductal associations with breast cancer risk in BCAC subjects (ER+ tumours only).

<p>SNPs showing differential lobular and ductal associations with breast cancer risk in BCAC subjects (ER+ tumours only).</p

Association with risk of breast cancer for rs11977670 stratified by breast cancer tumour subtypes (Pooled analysis, BCAC, GLACIER, UK PHASE II).

<p>Association with risk of breast cancer for rs11977670 stratified by breast cancer tumour subtypes (Pooled analysis, BCAC, GLACIER, UK PHASE II).</p

Forest plot for rs11977670.

<p>Forest plot for rs11977670.</p

Lobular cancer study design.

<p>Lobular cancer study design.</p