HER2 阳性乳腺癌骨转移的预后因素和生存预测：一项回顾性队列研究。

Prognostic factors and survival prediction in HER2-positive breast cancer with bone metastases: A retrospective cohort study.

机构信息

Department of General Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.

出版信息

Cancer Med. 2021 Nov;10(22):8114-8126. doi: 10.1002/cam4.4326. Epub 2021 Oct 6.

BACKGROUND

Bone is the most common metastatic site of breast cancer. The developmental pattern of bone metastasis differs in different molecular subtypes. The prognostic factors of HER2-positive breast cancer with bone metastases require further investigation. The goal of this retrospective study was to identify the clinical features and prognostic factors for HER2-positive patients with bone metastases.

METHODS

A total of 34,084 HER2-positive breast cancer cases and 1204 cases of bone metastases from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 were analyzed to identify clinical characteristics and prognostic factors. A nomogram was constructed based on the Cox proportional hazards regression model. The C-index, calibration curve, and receiver operating characteristic (ROC) were utilized for model validation.

RESULTS

In the HER2-positive breast cancer total population (34,084 cases), 6.2% developed metastatic diseases. Bone metastases accounted for 3.5% of the entire cohort and 56.7% of all metastatic cases. Univariate and multivariate Cox regression analyses identified seven prognostic factors for predicting cancer-specific survival (CSS) for HER2-positive breast cancer patients with bone metastases, including age, brain metastases, liver metastases, lung metastases, PR status, surgery, and chemotherapy. The C-index of the nomogram was 0.74 vs. 0.78 (for 3-year CSS) and 0.77 vs. 0.81 (for 5-year CSS) in the model and validation cohorts, respectively. The AUCs were 0.74 vs. 0.78 (for 3-year CSS) and 0.77 vs. 0.81 (for 5-year CSS) in the model and validation cohorts, respectively. The calibration curves indicated favorable agreement between the actual observations and the predictions.

CONCLUSION

Our study provided population-based clinical features and prognostic factors for HER2-positive breast cancer patients with bone metastases and we constructed a prognostic nomogram with reliable accuracy.

背景

骨是乳腺癌最常见的转移部位。不同分子亚型的骨转移发展模式不同。HER2 阳性乳腺癌伴骨转移的预后因素需要进一步研究。本回顾性研究的目的是确定 HER2 阳性骨转移患者的临床特征和预后因素。

方法

从 2010 年至 2015 年，我们对来自监测、流行病学和最终结果（SEER）数据库的 34084 例 HER2 阳性乳腺癌病例和 1204 例骨转移病例进行了分析，以确定临床特征和预后因素。基于 Cox 比例风险回归模型构建了列线图。C 指数、校准曲线和接受者操作特征（ROC）用于模型验证。

结果

在 HER2 阳性乳腺癌总人群（34084 例）中，有 6.2%发生了转移性疾病。骨转移占整个队列的 3.5%，占所有转移病例的 56.7%。单因素和多因素 Cox 回归分析确定了 7 个预测因素，用于预测 HER2 阳性乳腺癌伴骨转移患者的癌症特异性生存（CSS），包括年龄、脑转移、肝转移、肺转移、PR 状态、手术和化疗。列线图的 C 指数在模型和验证队列中分别为 0.74（用于 3 年 CSS）和 0.78（用于 5 年 CSS）。AUC 在模型和验证队列中分别为 0.74（用于 3 年 CSS）和 0.78（用于 5 年 CSS）。校准曲线表明实际观察值与预测值之间存在良好的一致性。