Chen et al described the M.D. Anderson Prognostic Index (MDAPI) for selecting a woman with breast cancer for breast conserving therapy after neoadjuvant chemotherapy. This can help identify a woman who may require more aggressive management to minimize the risk of recurrence. The authors are from the University of Texas M.D. Anderson Cancer Center in Houston, Texas.
Parameters:
(1) size of the tumor (diameter in cm)
(2) clinical lymph node status based on TNM staging
(3) lymphovascular space invasion
(4) tumor morphology
|
Clinical Status of Lymph Nodes |
N status |
|
no metastases |
N0 |
|
metastases to movable ipsilateral axillary nodes |
N1 |
|
(metastases to ipsilateral axillary lymph nodes which are fixed or matter) OR (metastases to internal mammary nodes without clinical disease in ipsilateral axillary lymph nodes) |
N2 |
|
(metastases to ipsilateral infraclavicular nodes) OR (metastases to ipsilateral supraclavicular lymph nodes) OR (metastases to both ipsilateral axillary and internal mammary lymph nodes) |
N3 |
|
Parameter |
Finding |
Points |
|
diameter of the tumor |
<= 2.0 cm |
0 |
|
|
> 2.0 cm |
1 |
|
lymph node status |
N0 or N1 |
0 |
|
|
N2 or N3 |
1 |
|
lymphovascular space |
negative |
0 |
|
|
positive |
1 |
|
lymphovascular space invasion |
absent |
0 |
|
|
present |
1 |
|
tumor morphology |
none residual |
0 |
|
|
solitary nodule |
0 |
|
|
multifocal disease |
1 |
MDAPI =
= SIM(points for all 4 parameters)
Interpretation:
• minimum index: 0
• maximum index: 4
• A patient in the low risk group is a candidate for breast conservation surgery after neoadjuvant chemotherapy.
• A patient in the high risk group may benefit from alternative treatment strategies.
|
MDAPI |
Risk Group |
10 Year Locoregional Recurrence Free Survival |
|
0 or 1 |
low risk |
95% |
|
2 |
intermediate risk |
70% |
|
3 or 4 |
high risk |
40% |
from Figure 2, page 692
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
