Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Gulou District, No.29, Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
BMC Geriatr. 2022 Apr 1;22(1):268. doi: 10.1186/s12877-022-02936-5.
PURPOSE: We aimed to analysis the impact of chemotherapy and establish prediction models of prognosis in early elderly triple negative breast cancer (eTNBC) by using machine learning. METHODS: We enrolled 4,696 patients in SEER Database who were 70 years or older, diagnosed with primary early TNBC(larger than 5 mm), from 2010 to 2016. The propensity-score matched method was utilized to reduce covariable imbalance. Univariable and multivariable analyses were used to compare breast cancer-specific survival(BCSS) and overall survival(OS). Nine models were developed by machine learning to predict the 5-year OS and BCSS for patients received chemotherapy. RESULTS: Compared to matched patients in no-chemotherapy group, multivariate analysis showed a better survival in chemotherapy group. Stratified analyses by stage demonstrated that patients with stage II and stage III other than stage I could benefit from chemotherapy. Further investigation in stage II found that chemotherapy was a better prognostic indicator for patients with T2N0M0 and stage IIb, but not in T1N1M0. Patients with grade III could achieve a better survival by receiving chemotherapy, but those with grade I and II couldn't. With 0.75 in 5-year BCSS and 0.81 in 5-year OS for AUC, the LightGBM outperformed other algorithms. CONCLUSION: For early eTNBC patients with stage I, T1N1M0 and grade I-II, chemotherapy couldn't improve survival. Therefore, de-escalation therapy might be appropriate for selected patients. The LightGBM is a trustful model to predict the survival and provide precious systemic treatment for patients received chemotherapy.
目的:我们旨在通过机器学习分析化疗的影响,并建立早期老年三阴性乳腺癌(eTNBC)的预后预测模型。
方法:我们纳入了 SEER 数据库中 4696 名年龄在 70 岁及以上、诊断为原发性早期 TNBC(大于 5mm)、发病时间在 2010 年至 2016 年的患者。采用倾向评分匹配法减少协变量的不平衡。单变量和多变量分析用于比较乳腺癌特异性生存(BCSS)和总生存(OS)。采用机器学习方法建立了 9 个模型来预测接受化疗的患者的 5 年 OS 和 BCSS。
结果:与未化疗组的匹配患者相比,多变量分析显示化疗组的生存情况更好。分层分析显示,除了 I 期以外,II 期和 III 期患者均可从化疗中获益。进一步对 II 期患者进行研究发现,化疗是 T2N0M0 和 IIb 期患者的更好预后指标,但不是 T1N1M0 期患者。III 级患者接受化疗可获得更好的生存,但 I 级和 II 级患者不行。LightGBM 在 5 年 BCSS 的 AUC 为 0.75,在 5 年 OS 的 AUC 为 0.81,表现优于其他算法。
结论:对于 I 期、T1N1M0 和 I 级和 II 级的早期 eTNBC 患者,化疗并不能改善生存。因此,对于选定的患者,降级治疗可能是合适的。LightGBM 是一种可靠的模型,可以预测生存情况,并为接受化疗的患者提供宝贵的系统治疗。
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