Sun Wei, Cheng Minghua, Zhou Huaqiang, Huang Wenqi, Qiu Zeting
Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China.
Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
J Cancer. 2019 Jan 1;10(3):583-593. doi: 10.7150/jca.28991. eCollection 2019.
Male breast cancer (MBC) is a rare tumor with few cases for research. Using the Surveillance, Epidemiology, and End Results program database, we carried out a competing risk analysis in patients with primary nonmetastatic MBC and built a predictive nomogram. We extracted primary nonmetastatic MBC patients according to the inclusion and exclusion criteria. Cumulative incidence function (CIF) and proportional subdistribution hazard model were adopted to explore risk factors for breast cancer-specific death (BCSD) and other cause-specific death (OCSD). Then we built a nomogram to predict the 3-year, 5-year and 8-year probabilities of BCSD and OCSD. C-indexes, Brier scores and calibration curves were chosen for validation. We identified 1,978 nonmetastatic MBC patients finally. CIF analysis showed that the 3-year, 5-year and 8-year mortalities were 5.2%, 10.6% and 16.5% for BCSD, and 6.1%, 9.6% and 14.4% for OCSD. After adjustment of Fine and Gray models, black race, PR (-), advanced T/N/grade and no surgery were independently associated with BCSD. Meanwhile, elderly, unmarried status, advanced AJCC stage and no chemotherapy resulted in OCSD more possibly. A graphic nomogram was developed according to the coefficients from the Fine and Gray models. The calibration curves displayed exceptionally, with C-indexes nearly larger than 0.700 and Brier scores nearly smaller than 0.100. The competing risk nomogram showed good accuracy for predictive prognosis in nonmetastatic MBC patients. It was a useful implement to evaluate crude mortalities of BCSD and OCSD, and help clinicians to choose appropriate therapeutic plans.
男性乳腺癌（MBC）是一种罕见肿瘤，可供研究的病例较少。利用监测、流行病学和最终结果（SEER）计划数据库，我们对原发性非转移性MBC患者进行了竞争风险分析，并构建了一个预测列线图。我们根据纳入和排除标准提取原发性非转移性MBC患者。采用累积发病率函数（CIF）和比例子分布风险模型来探究乳腺癌特异性死亡（BCSD）和其他原因特异性死亡（OCSD）的危险因素。然后我们构建了一个列线图来预测BCSD和OCSD的3年、5年和8年概率。选择C指数、Brier评分和校准曲线进行验证。我们最终确定了1978例非转移性MBC患者。CIF分析显示，BCSD的3年、5年和8年死亡率分别为5.2%、10.6%和16.5%，OCSD的分别为6.1%、9.6%和14.4%。在调整Fine和Gray模型后，黑人种族、孕激素受体（PR）阴性、T/N分期/分级较高以及未进行手术与BCSD独立相关。同时，老年、未婚状态、美国癌症联合委员会（AJCC）分期较高以及未进行化疗更有可能导致OCSD。根据Fine和Gray模型的系数绘制了一个图形列线图。校准曲线表现出色，C指数几乎均大于0.700，Brier评分几乎均小于0.100。该竞争风险列线图在预测非转移性MBC患者的预后方面显示出良好的准确性。它是评估BCSD和OCSD粗死亡率的有用工具，并有助于临床医生选择合适的治疗方案。
