Sun Wei, Jiang Yi-Zhou, Liu Yi-Rong, Ma Ding, Shao Zhi-Ming
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.
Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.
Oncotarget. 2016 Apr 12;7(15):20496-506. doi: 10.18632/oncotarget.7975.
Luminal breast cancer constitutes a group of highly heterogeneous diseases with a sustained high risk of late recurrence. We aimed to develop comprehensive and practical nomograms to better estimate the long-term survival of luminal breast cancer.Patients with luminal breast cancer diagnosed between 1990 and 2006 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into the training (n = 87,867) and validation (n = 88,215) cohorts. The cumulative incidence function (CIF) and a competing-risks model were used to estimate the probability of breast cancer-specific survival (BCSS) and death from other causes. We integrated significant prognostic factors to build nomograms and subjected the nomograms to bootstrap internal validation and to external validation.We screened 176,082 luminal breast cancer cases. The 5- and 10-year probabilities of overall death were 0.089 and 0.202, respectively. The 5- and 10-year probabilities of breast cancer-specific mortality (BCSM) were 0.053 and 0.112, respectively. Nine independent prognostic factors for both OS and BCSS were integrated to construct the nomograms. The calibration curves for the probabilities of 5- and 10-year OS and BCSS showed excellent agreement between the nomogram prediction and actual observation. The C-indexes of the nomograms were high in both internal validation (0.732 for OS and 0.800 for BCSS) and external validation (0.731 for OS and 0.794 for BCSS).We established nomograms that accurately predict OS and BCSS for patients with luminal breast cancer. The nomograms can identify patients with higher risk of late overall mortality and BCSM, helping physicians in facilitating individualized treatment.
管腔型乳腺癌是一组高度异质性疾病，具有晚期复发的持续高风险。我们旨在开发全面且实用的列线图，以更好地估计管腔型乳腺癌的长期生存率。从监测、流行病学和最终结果（SEER）数据库中检索出1990年至2006年间诊断为管腔型乳腺癌的患者，并将其随机分为训练队列（n = 87,867）和验证队列（n = 88,215）。使用累积发病率函数（CIF）和竞争风险模型来估计乳腺癌特异性生存（BCSS）和其他原因导致死亡的概率。我们整合了显著的预后因素来构建列线图，并对列线图进行自助法内部验证和外部验证。我们筛选了176,082例管腔型乳腺癌病例。总体死亡的5年和10年概率分别为0.089和0.202。乳腺癌特异性死亡率（BCSM）的5年和10年概率分别为0.053和0.112。整合了9个独立的总生存期（OS）和BCSS预后因素来构建列线图。5年和10年OS及BCSS概率的校准曲线显示列线图预测与实际观察之间具有良好的一致性。列线图的C指数在内部验证（OS为0.732，BCSS为0.800）和外部验证（OS为0.731，BCSS为0.794）中均较高。我们建立了能准确预测管腔型乳腺癌患者OS和BCSS的列线图。这些列线图可以识别出晚期总体死亡和BCSM风险较高的患者，帮助医生制定个体化治疗方案。
