Ji Lei, Fan Lei, Zhu Xiuzhi, Gao Yu, Wang Zhonghua
Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Oncol. 2020 Sep 2;10:1342. doi: 10.3389/fonc.2020.01342. eCollection 2020.
Breast cancer with liver metastasis consists of a group of heterogeneous diseases, and survival time may be significantly different, ranging from a few months to several years. The present study aimed to develop and externally validate a prognostic model for breast cancer with liver metastasis (BCLM). In total, 1022 eligible patients from January 2007 to December 2018 were selected from Fudan University Shanghai Cancer Center (FUSCC) and were temporally in the training ( = 715) and validation ( = 307) set. According to regression coefficients found in the multivariate Cox regression analysis, the final results were transformed into the prognostic scores. On the basis of these scores, patients were finally classified into three risk groups, including low-, intermediate-, and high-risk groups. Bootstrapping was used for internal validation. Then, time-dependent receiver operating characteristic (ROC) curves and calibration plots were used to assess discrimination and calibration of this prognostic model in the validation set. Molecular subtypes, metastatic-free interval (MFI), extrahepatic metastasis, and liver function tests were identified as independent prognostic factors in the multivariate analysis. According to risk stratification, intermediate-risk (hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.74-2.58, < 0.001) and high-risk groups (HR 6.94, 95% CI 5.25-9.16, < 0.001) had significantly worse prognoses in comparison with the low-risk group regarding overall survival (OS) from the time of metastasis. The median OS in these three groups were 39.97, 21.03, and 8.80 months, respectively. These results were confirmed in the internal and external validation cohorts. Based on molecular classification of tumors, routine laboratory tests, and other clinical information easily accessible in daily clinical practice, we developed a clinical tool for BCLM patients to predict their prognosis. Moreover, it may be useful for identifying the subgroup with unfavorable prognosis and individualization of treatment.
伴有肝转移的乳腺癌是一组异质性疾病，生存时间可能有显著差异，从几个月到数年不等。本研究旨在开发并外部验证一种伴有肝转移乳腺癌（BCLM）的预后模型。总共从复旦大学附属肿瘤医院（FUSCC）选取了2007年1月至2018年12月期间符合条件的1022例患者，并将其临时分为训练集（n = 715）和验证集（n = 307）。根据多变量Cox回归分析中发现的回归系数，将最终结果转化为预后评分。基于这些评分，患者最终被分为三个风险组，包括低风险、中风险和高风险组。采用自举法进行内部验证。然后，使用时间依赖性受试者工作特征（ROC）曲线和校准图来评估该预后模型在验证集中的区分度和校准度。分子亚型、无转移间期（MFI）、肝外转移和肝功能检查在多变量分析中被确定为独立的预后因素。根据风险分层，与低风险组相比，中风险组（风险比（HR）2.12，95%置信区间（CI）1.74 - 2.58，P < 0.001）和高风险组（HR 6.94，95%CI 5.25 - 9.16，P < 0.001）从转移时起的总生存期（OS）预后明显更差。这三组的中位OS分别为39.97、21.03和8.80个月。这些结果在内部和外部验证队列中得到了证实。基于肿瘤的分子分类、常规实验室检查以及日常临床实践中易于获取的其他临床信息，我们为BCLM患者开发了一种临床工具来预测他们的预后。此外，它可能有助于识别预后不良的亚组并实现治疗个体化。
