Department of Oncology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Shantou University Medical College, Shantou, Guangdong, China.
PLoS One. 2020 Nov 10;15(11):e0242155. doi: 10.1371/journal.pone.0242155. eCollection 2020.
For patients initially diagnosed with metastatic Her2-positive breast cancer (MHBC), we intended to construct a nomogram with risk stratification to predict prognosis and to explore the role of local surgery.
We retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier (KM) method and log-rank test were used for the selection of significant variables. Cox regression analysis and Fine-Gray test were utilized to confirm independent prognostic factors of overall survival (OS) and breast cancer-specific survival (BCSS). A nomogram predicting 1-year, 3-year, and 5-year OS was developed and validated. Patients were stratified based on the optimal cut-off values of total personal score. KM method and log-rank test were used to estimate OS prognosis and benefit from local surgery and chemotherapy.
There were 1680 and 717 patients in the training and validation cohort. Age, race, marriage, T stage, estrogen receptor (ER) status, visceral metastasis (bone, brain, liver and lung) were identified as independent prognostic factors for OS and BCSS, while histology was also corelated with OS. C-indexes in the training and validation cohort were 0.70 and 0.68, respectively. Calibration plots indicated precise predictive ability. The total population was divided into low- (<141 points), intermediate- (142-208 points), and high-risk (>208 points) prognostic groups. Local surgery and chemotherapy brought various degrees of survival benefit for patients with diverse-risk prognosis.
We constructed a model with accurate prediction and discrimination. It would provide a reference for clinicians' decision-making. Surgery on the primary lesion was recommended for patients with good physical performance status, while further study on optimal surgical opportunity was needed.
对于最初诊断为转移性 Her2 阳性乳腺癌（MHBC）的患者，我们旨在构建一个具有风险分层的列线图来预测预后，并探讨局部手术的作用。
我们从监测、流行病学和最终结果（SEER）数据库中检索数据。Kaplan-Meier（KM）方法和对数秩检验用于选择显著变量。Cox 回归分析和 Fine-Gray 检验用于确认总生存（OS）和乳腺癌特异性生存（BCSS）的独立预后因素。开发并验证了预测 1 年、3 年和 5 年 OS 的列线图。根据总个人评分的最佳截断值对患者进行分层。KM 方法和对数秩检验用于估计 OS 预后以及局部手术和化疗的获益。
在训练和验证队列中分别有 1680 例和 717 例患者。年龄、种族、婚姻、T 分期、雌激素受体（ER）状态、内脏转移（骨、脑、肝和肺）被确定为 OS 和 BCSS 的独立预后因素，而组织学也与 OS 相关。训练和验证队列的 C 指数分别为 0.70 和 0.68。校准图表明具有精确的预测能力。将总人群分为低风险（<141 分）、中风险（142-208 分）和高风险（>208 分）预后组。局部手术和化疗为不同风险预后的患者带来了不同程度的生存获益。
我们构建了一个具有准确预测和区分能力的模型。它将为临床医生的决策提供参考。对于身体状况良好的患者，建议对原发性病变进行手术，而需要进一步研究最佳手术时机。
