Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
The First Clinical College of Nanjing Medical University, Nanjing, China.
Cancer Med. 2021 Dec;10(23):8662-8672. doi: 10.1002/cam4.4351. Epub 2021 Oct 13.
With life span extending, breast cancer (BC) survivors may face the possibility of developing second primary cancer (SPC) and considerably shorten survivorship. However, little is known about multiple primary cancer (MPC) patients with nonmetastatic breast cancer as a first primary malignancy (BCFPM).
Here, we retrospectively analyzed data on cancer survivors with BCFPM diagnosed between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic factors for breast cancer-specific survival (BCSS) were ascertained by the stepwise regression analysis and a competing risk model, and were integrated to the establishment of prognostic nomogram, of which the accuracy was measured by the calibration curve and the concordance index (C-index).
In total, 8616 patients were identified with 4.6% of 3-year breast cancer- specific death (BCSD) and 8.6% of 5-year BCSD. The most common SPC among BCFPM patients were female BC and lung cancer. Besides, the median latency time between BC and SPC was 22 months. At a ratio of 7:3, all patients were randomly categorized into a training cohort (n = 6032) and a validation cohort (n = 2584). By a proportional subdistribution hazards regression analysis, the following factors were considered to own independent prognostic abilities of BCSS: subtypes, grade, T classification, N classification, radiation, and sites of SPC. The nomogram could accurately predict 3-year and 5-year breast cancer-associated survival of BCFPM patients with high internal and external validated C-index, 0.715 (95% CI, 0.691-0.739), and 0.683 (95% CI, 0.642-0.724), respectively.
BC survivors remained a high risk of developing SPC and considerably shortened survival time. In this study, a favorable nomogram was constructed to as a prediction model for 3-year and 5-year BCSS of BCFPM patients, largely intending to prolong the life of these patients by assisting clinicians to make individualized follow-up plans.
随着寿命的延长，乳腺癌（BC）幸存者可能面临发展第二原发癌（SPC）的可能性，并显著缩短生存时间。然而，对于作为第一原发恶性肿瘤（BCFPM）的非转移性乳腺癌的多原发癌（MPC）患者知之甚少。
在这里，我们回顾性分析了 2010 年至 2015 年期间从监测、流行病学和最终结果（SEER）数据库中诊断出的 BCFPM 癌症幸存者的数据。通过逐步回归分析和竞争风险模型确定乳腺癌特异性生存（BCSS）的预后因素，并将其整合到预后列线图的建立中，通过校准曲线和一致性指数（C-index）来衡量其准确性。
共有 8616 名患者被确定，其中 3 年乳腺癌特异性死亡（BCSD）的比例为 4.6%，5 年 BCSD 的比例为 8.6%。BCFPM 患者中最常见的 SPC 是女性 BC 和肺癌。此外，BC 和 SPC 之间的中位潜伏期时间为 22 个月。按 7:3 的比例，所有患者被随机分为训练队列（n=6032）和验证队列（n=2584）。通过比例亚分布危害回归分析，以下因素被认为具有独立的 BCSS 预后能力：亚型、分级、T 分类、N 分类、放疗和 SPC 部位。该列线图能够准确预测 BCFPM 患者的 3 年和 5 年乳腺癌相关生存，内部和外部验证的 C-index 分别为 0.715（95%CI，0.691-0.739）和 0.683（95%CI，0.642-0.724）。
BC 幸存者仍然有很高的发展 SPC 的风险，并且生存时间显著缩短。在这项研究中，构建了一个有利的列线图，作为 BCFPM 患者 3 年和 5 年 BCSS 的预测模型，主要旨在通过帮助临床医生制定个体化的随访计划来延长这些患者的生命。
