Wang Zhan, Cheng Yonggang, Chen Shi, Shao Haiyu, Chen Xiaowei, Wang Zenan, Wang Yucheng, Zhou Hao, Chen Tao, Lin Nong, Ye Zhaoming
Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
Department of Orthopaedics, Ninghai First Hospital, Ninghai 315600, China.
Ann Transl Med. 2020 Mar;8(5):197. doi: 10.21037/atm.2020.01.37.
There is a paucity of literature about prognostic evaluation for patients with breast cancer (BC) and bone metastasis at presentation. To date, little is known about how to accurately predict the prognosis of BC patients with bone metastasis at presentation. Thus, an accurate prediction tool of prognosis in this population is urgently needed. Our goal is to construct novel and prognostic nomograms for BC patients with bone metastasis at presentation.
We searched Surveillance, Epidemiology, and End Results (SEER) database for BC patients with bone metastasis at presentation between 2010 and 2016. Multivariate analysis was performed to obtain significantly independent variables. Then, novel prognostic nomograms were constructed based on those independent predictors.
Tumor grade, histological type, primary tumor size, tumor subtype, surgery, chemotherapy and number of metastatic organs except bone were recognized as significantly independent variables of both overall survival (OS) and cancer-specific survival (CSS). Then those significant variables were integrated to construct nomograms for 3- and 5-year survival. Calibration plots for the 3- and 5-year survival in training and validation sets showed that the prediction curve was close to a 45 degree slash. The C-indices of OS in training and validation cohorts were 0.705 and 0.678, respectively. Similar results were observed for CSS in training and validation cohorts.
Our proposed nomograms can effectively and accurately predict the prognosis of BC patients with bone metastasis at presentation, which provide a basis for individual treatments for metastatic lesions.
目前关于初诊时伴有骨转移的乳腺癌(BC)患者预后评估的文献较少。迄今为止,对于如何准确预测初诊时伴有骨转移的BC患者的预后知之甚少。因此,迫切需要一种针对该人群的准确预后预测工具。我们的目标是为初诊时伴有骨转移的BC患者构建新的预后列线图。
我们在监测、流行病学和最终结果(SEER)数据库中搜索了2010年至2016年初诊时伴有骨转移的BC患者。进行多变量分析以获得显著独立变量。然后,基于这些独立预测因素构建新的预后列线图。
肿瘤分级、组织学类型、原发肿瘤大小、肿瘤亚型、手术、化疗以及除骨以外的转移器官数量被确定为总生存期(OS)和癌症特异性生存期(CSS)的显著独立变量。然后将这些显著变量整合以构建3年和5年生存期的列线图。训练集和验证集中3年和5年生存期的校准图显示预测曲线接近45度斜线。训练队列和验证队列中OS的C指数分别为0.705和0.678。CSS在训练队列和验证队列中观察到类似结果。
我们提出的列线图可以有效且准确地预测初诊时伴有骨转移的BC患者的预后,为转移性病变的个体化治疗提供依据。