Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266071, China.
Medical College of Qingdao University, Qingdao, 266000 Shandong, China.
Biomed Res Int. 2020 Dec 8;2020:1972064. doi: 10.1155/2020/1972064. eCollection 2020.
Overall survival (OS) and cancer-specific survival (CSS) of luminal A breast cancer (BC) patients with bone metastasis remain poor and vary dramatically from person to person. Our goal was to build two universally applicable nomograms to accurately predict OS and CSS for luminal A patients with bone metastasis.
The data were collected from the Surveillance, Epidemiology, and End Results (SEER) database for luminal A BC patients with bone metastasis between 2010 and 2015. Univariate and multivariate Cox regression analyses were to assess and identify independent risk factors of OS and CSS. Integrating all significant predictors, nomograms and risk group stratification model was developed. The performance of the nomogram was validated with concordance index (C-index), calibration plots, and decision curve analyses (DCA) for discriminative ability, calibration, and clinical utility, respectively.
3171 luminal A BC patients with bone metastasis were included. Through univariate and multivariate Cox regression analyses, 12 variables were identified as both independent OS- and CSS-related factors, including age, race, primary site, histology grade, tumor size, surgery, brain metastasis, liver metastasis, lung metastasis, estrogen receptor status, progesterone receptor status, and insurance. Our nomograms for 1-, 3-, and 5-year survival were based on those significant prognostic factors to develop. The C-indexes of OS- and CSS-nomograms in the training cohort were 0.701 and 0.704, respectively. Similar results were obtained in the validation cohort. The calibration curves and DCA presented satisfactory calibration and clinical utility.
Two nomograms have good discrimination, calibration, and clinical utility, can accurately and effectively predict the prognosis of patients, and may benefit for clinical decision-making. In high-risk patients, more aggressive therapy and closer surveillance should be considered.
患有骨转移的 luminal A 型乳腺癌（BC）患者的总生存（OS）和癌症特异性生存（CSS）仍然很差，且因人而异，差异巨大。我们的目标是建立两个普遍适用的列线图，以准确预测 luminal A 型骨转移患者的 OS 和 CSS。
该数据来自 2010 年至 2015 年期间监测、流行病学和最终结果（SEER）数据库中患有骨转移的 luminal A 型 BC 患者。采用单因素和多因素 Cox 回归分析评估并确定 OS 和 CSS 的独立危险因素。整合所有显著预测因子，建立列线图和风险组分层模型。通过一致性指数（C 指数）、校准图和决策曲线分析（DCA）分别评估列线图的判别能力、校准和临床实用性来验证其性能。
共纳入 3171 例 luminal A 型 BC 伴骨转移患者。通过单因素和多因素 Cox 回归分析，确定了 12 个变量为 OS 和 CSS 的独立相关因素，包括年龄、种族、原发部位、组织学分级、肿瘤大小、手术、脑转移、肝转移、肺转移、雌激素受体状态、孕激素受体状态和保险状况。我们的列线图是基于这些显著的预后因素，为预测 1 年、3 年和 5 年生存率而建立的。在训练队列中，OS 和 CSS 列线图的 C 指数分别为 0.701 和 0.704，在验证队列中也得到了类似的结果。校准曲线和 DCA 显示了良好的校准和临床实用性。
两个列线图具有良好的判别、校准和临床实用性，能准确有效地预测患者的预后，可能有助于临床决策。在高危患者中，应考虑更积极的治疗和更密切的监测。
