Xie Ning, Xu Ying, Zhong Ying, Li Junwei, Yao Herui, Qin Tao
Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2021 Feb 1;10:617593. doi: 10.3389/fonc.2020.617593. eCollection 2020.
PURPOSE: Triple-negative breast cancer (TNBC) is characterized by high malignancy and a poor prognosis. Patients with TNBC who survive longer than 5 years represent a unique portion of the population. This study aimed to analyze the clinicopathological features, explore prognostic factors, and evaluate treatment options for these patients. METHODS: A total of 24,943 TNBC patients were enrolled from the national Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2016. The patients were divided into three groups: group 1, survival time <3 years; group 2, 3-5 years; and group 3, survival time ≥5 years. The overall survival (OS) and breast cancer cause-specific survival (BCSS) were primarily assessed in this study. A propensity score analysis was used to avoid bias caused by the data selection criteria. We used a Cox hazard ratio analysis to determine prognostic factors, which were selected as nomogram parameters to develop a model for predicting patient survival. RESULTS: Patients who survived longer than 5 years were more likely to be younger than 55 years, Caucasian, and exhibit a lower AJCC stage, N stage, distant metastasis, lymph node (LN) involvement, and tumor size than those with a shorter survival time ( < 0.05). The multivariable Cox regression analysis showed that age, race, tumor size, LN status, and chemotherapy were independent prognostic factors. Subgroup analyses for patients with tumors ≤20 mm displayed a superior OS and BCSS for breast-conserving surgery (BCS) not treated with a mastectomy. BCS provided at least an equivalent prognosis to a mastectomy in patients with tumors larger than 20 mm. A nomogram with a C-index of 0.776 (95% confidence interval: 0.767-0.785) was developed to predict the 3- and 5-year survival probability for the patients with TNBC. CONCLUSION: A localized surgical approach may represent a superior choice for TNBC patients with a survival time longer than 5 years. Our study indicated that age, race, tumor size, LN status, and chemotherapy were independent prognostic factors. A prognostic nomogram directly quantified patient risk and was better able to predict long-term survival in TNBC patients.
目的：三阴性乳腺癌（TNBC）具有高恶性和预后差的特点。生存超过5年的TNBC患者是一个独特的群体。本研究旨在分析这些患者的临床病理特征，探索预后因素，并评估治疗方案。 方法：2010年1月至2016年12月期间，从国家监测、流行病学和最终结果（SEER）数据库中纳入了总共24943例TNBC患者。患者被分为三组：第1组，生存时间<3年；第2组，3 - 5年；第3组，生存时间≥5年。本研究主要评估总生存期（OS）和乳腺癌特异性生存期（BCSS）。采用倾向评分分析以避免数据选择标准引起的偏差。我们使用Cox风险比分析来确定预后因素，将其作为列线图参数以建立预测患者生存的模型。 结果：与生存时间较短（<5年）的患者相比，生存超过5年的患者更可能年龄小于55岁、为白种人，且AJCC分期、N分期、远处转移、淋巴结（LN）受累及肿瘤大小更低（P<0.05）。多变量Cox回归分析显示，年龄、种族、肿瘤大小、LN状态和化疗是独立的预后因素。对肿瘤≤20 mm患者的亚组分析显示，保乳手术（BCS）未行乳房切除术的患者具有更好的OS和BCSS。对于肿瘤大于20 mm的患者，BCS提供的预后至少与乳房切除术相当。开发了一个C指数为0.776（95%置信区间：0.767 - 0.785）的列线图，以预测TNBC患者的3年和5年生存概率。 结论：对于生存时间超过5年的TNBC患者，局部手术方法可能是更好的选择。我们的研究表明，年龄、种族、肿瘤大小、LN状态和化疗是独立的预后因素。预后列线图直接量化了患者风险，并且能够更好地预测TNBC患者的长期生存。
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