Yao Yu-Bin, Zheng Xue-Er, Luo Xiao-Bin, Wu Ai-Min
The First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000, Zhejiang, China.
The First Clinical Medical College of Zhejiang Chinese Medical University Hangzhou 310053, Zhejiang, China.
Am J Transl Res. 2021 Sep 15;13(9):10248-10261. eCollection 2021.
Bone is the most common metastatic site for breast cancer, and patients' condition will deteriorate when it occurs.
We performed a retrospective analysis on 6482 breast cancer patients with bone metastases (BCBM), who were selected from the Surveillance, Epidemiology, and End Result (SEER) 18 registry database. The optimal age cut-points were generated by using the X-tile software. By using Cox regression, we selected independent prognostic factors from 21 variables, and plotted a visual nomogram to predict the probability of surviving to the median survival time. We also diagrammed a competing risk nomogram on the basis of competitive risk model.
Compared with other three common metastatic sites, the incidence of bone metastasis was the highest for patients with breast cancer. The incidence of BCBM peaked around the age of 60, and a large majority of patients were between the ages of 50 and 70. The survival rate decreased with age, and the median survival time was about 19 months. Factors of age, race, marital status, grade, human epidermal growth factor receptor-2 (HER2) receptor, hormone receptor, concurrent brain metastasis, concurrent liver metastasis, concurrent lung metastasis, surgery and chemotherapy are strongly related to the prognosis of patients with BCBM. It was revealed that the C-index of the nomogram was 0.72 and the calibration curves showed good agreement between the nomogram prediction and actual observation.
Our practical nomograms provide a visual and user-friendly tool in the risk evaluation and prognostic prediction for breast cancer patients with bone metastases.
骨是乳腺癌最常见的转移部位，一旦发生骨转移患者病情会恶化。
我们对6482例骨转移乳腺癌患者（BCBM）进行了回顾性分析，这些患者选自监测、流行病学和最终结果（SEER）18登记数据库。使用X-tile软件生成最佳年龄切点。通过Cox回归，我们从21个变量中选择独立预后因素，并绘制可视化列线图以预测存活至中位生存时间的概率。我们还基于竞争风险模型绘制了竞争风险列线图。
与其他三个常见转移部位相比，乳腺癌患者骨转移的发生率最高。BCBM的发生率在60岁左右达到峰值，绝大多数患者年龄在50至70岁之间。生存率随年龄下降，中位生存时间约为19个月。年龄、种族、婚姻状况、分级、人表皮生长因子受体2（HER2）受体、激素受体、同时发生脑转移、同时发生肝转移、同时发生肺转移、手术和化疗等因素与BCBM患者的预后密切相关。结果显示列线图的C指数为0.72，校准曲线表明列线图预测与实际观察结果之间具有良好的一致性。
我们实用的列线图为骨转移乳腺癌患者的风险评估和预后预测提供了一种直观且用户友好的工具。
