Fu Jianfei, Wu Lunpo, Jiang Mengjie, Li Dan, Jiang Ting, Hong Zhongwu, Wang Fan, Li Shuguang
Department of Oncology, Zhejiang University Jinhua hospital, Jinhua, Zhejiang Province, China.
Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
PLoS One. 2016 Oct 19;11(10):e0164921. doi: 10.1371/journal.pone.0164921. eCollection 2016.
The features related to the prognosis of patients with mucinous breast cancer (MBC) remain controversial. We aimed to explore the prognostic factors of MBC and develop a nomogram for predicting survival outcomes.
The Surveillance, Epidemiology, and End Results (SEER) database was searched to identify 139611 women with resectable breast cancer from 1990 to 2007. Survival curves were generated using Kaplan-Meier methods. The 5-year and 10-year cancer-specific survival (CSS) rates were calculated using the Life-Table method. Based on Cox models, a nomogram was constructed to predict the probabilities of CSS for an individual patient. The competing risk regression model was used to analyse the specific survival of patients with MBC.
There were 136569 (97.82%) infiltrative ductal cancer (IDC) patients and 3042 (2.18%) MBC patients. Patients with MBC had less lymph node involvement, a higher frequency of well-differentiated lesions, and more estrogen receptor (ER)-positive tumors. Patients with MBC had significantly higher 5 and10-year CSS rates (98.23 and 96.03%, respectively) than patients with IDC (91.44 and 85.48%, respectively). Univariate and multivariate analyses showed that MBC was an independent factor for better prognosis. As for patients with MBC, the event of death caused by another disease exceeded the event of death caused by breast cancer. A competing risk regression model further showed that lymph node involvement, poorly differentiated grade and advanced T-classification were independent factors of poor prognosis in patients with MBC. The Nomogram can accurately predict CSS with a high C-index (0.816). Risk scores developed from the nomogram can more accurately predict the prognosis of patients with MBC (C-index = 0.789) than the traditional TNM system (C-index = 0.704, P< 0.001).
Patients with MBC have a better prognosis than patients with IDC. Nomograms could help clinicians make more informed decisions in clinical practice. The competing risk regression model, as a more rational model, is recommended for use in the survival analysis of patients with MBC in the future.
黏液性乳腺癌（MBC）患者预后相关特征仍存在争议。我们旨在探讨MBC的预后因素并开发一种预测生存结局的列线图。
检索监测、流行病学和最终结果（SEER）数据库，以识别1990年至2007年期间139611例可切除乳腺癌女性患者。采用Kaplan-Meier方法生成生存曲线。使用寿命表法计算5年和10年癌症特异性生存率（CSS）。基于Cox模型构建列线图，以预测个体患者的CSS概率。采用竞争风险回归模型分析MBC患者的特异性生存情况。
浸润性导管癌（IDC）患者有136569例（97.82%），MBC患者有3042例（2.18%）。MBC患者的淋巴结受累较少，高分化病变频率较高，雌激素受体（ER）阳性肿瘤较多。MBC患者的5年和10年CSS率（分别为98.23%和96.03%）显著高于IDC患者（分别为91.44%和85.48%）。单因素和多因素分析表明，MBC是预后较好的独立因素。对于MBC患者，由其他疾病导致的死亡事件超过了由乳腺癌导致的死亡事件。竞争风险回归模型进一步表明，淋巴结受累、低分化级别和晚期T分期是MBC患者预后不良的独立因素。该列线图可通过高C指数（0.816）准确预测CSS。与传统TNM系统（C指数 = 0.704，P < 0.001）相比，由列线图得出的风险评分能更准确地预测MBC患者的预后（C指数 = 0.789）。
MBC患者的预后优于IDC患者。列线图有助于临床医生在临床实践中做出更明智的决策。竞争风险回归模型作为一种更合理的模型，建议未来用于MBC患者的生存分析。
