Cui Hanxiao, Dai Luyao, Bao Yuanhang, Hu Liqun, Zhou Zhangjian, Wang Meng, Lin Shuai, Wu Hao, Ma Xiaobin, Kang Huafeng
Department of Oncology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
School of Basic Medical Sciences, Xi'an Key Laboratory of Immune Related Diseases, Xi'an Jiaotong University, Xi'an, China.
Front Oncol. 2022 May 4;12:819531. doi: 10.3389/fonc.2022.819531. eCollection 2022.
The efficacy of primary tumor surgery on survival in female patients with stage IV breast cancer (BC) remains unclear. Our study endeavored to develop comprehensive competing risk nomograms to predict clinical outcomes and guide precision treatment in these patients.
A total of 12281 patients who had distant metastasis at initial BC diagnosis between 2010 and 2017 in the Surveillance Epidemiology and End Results (SEER) database, were enrolled in this study. First, we assessed the impacts of primary tumor surgery on overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan-Meier curves. Then subgroup analyses stratified by different metastatic patterns were performed using Cox and competing risk models (CRM). Based on the filtered independent prognostic parameters by CRM, we established two nomograms to predict the probability of breast cancer-specific death (BCSD) at 1-,2- and 3-year intervals. Furthermore, calibration curves and area under the curves (AUC) were conducted for validation.
Kaplan-Meier analysis revealed that surgery was associated with better OS and BCSS (P<0.001). Subgroup analyses demonstrated that in bone-only metastases pattern, relative to breast-conserving surgery (BCS), patients receiving mastectomy had worse prognosis and the poorest survival belonged to non-surgery individuals (BCSS: mastectomy: HR=1.35; 95%CI=1.15-1.60; non-surgery: 2.42; 2.08-2.82; OS: mastectomy: 1.44; 1.23-1.68; non-surgery: 2.40; 2.08-2.78). Additionally, no survival difference was observed between BCS and reconstruction recipients (BCSS: HR=1.10; 95%CI=0.85-1.43; OS: 1.11; 0.86-1.44). Furthermore, patients undergoing BCS possessed similar BCSS with mastectomy recipients as well as reconstruction recipients in viscera metastases pattern, whereas non-surgery individuals had a worse survival (mastectomy: HR=1.04; 95%CI=0.92-1.18; reconstruction: 0.86; 0.69-1.06; non-surgery: 1.83; 1.63-2.05). Two competing risk nomograms of distinct metastatic patterns were established to comprehensively predict the survival of patients. Calibration curves indicated the terrific consistency of the models. Moreover, the AUC values in the training and validation sets were in the range of 0.70-0.80, exhibiting good specificity and sensitivity.
The surgery implementation was associated with a lower probability of BCSD in stage-IV BC patients. Our nomograms could offer a relatively accurate and individualized prediction of the cumulative incidence rate of BCSD after primary tumor resection.
原发性肿瘤手术对IV期乳腺癌（BC）女性患者生存的疗效仍不明确。我们的研究致力于开发全面的竞争风险列线图，以预测这些患者的临床结局并指导精准治疗。
本研究纳入了监测、流行病学和最终结果（SEER）数据库中2010年至2017年首次诊断为BC时已有远处转移的12281例患者。首先，我们使用Kaplan-Meier曲线评估原发性肿瘤手术对总生存期（OS）和乳腺癌特异性生存期（BCSS）的影响。然后，使用Cox模型和竞争风险模型（CRM）按不同转移模式进行亚组分析。基于CRM筛选出的独立预后参数，我们建立了两个列线图来预测1年、2年和3年间隔的乳腺癌特异性死亡（BCSD）概率。此外，还进行了校准曲线和曲线下面积（AUC）分析以进行验证。
Kaplan-Meier分析显示，手术与更好的OS和BCSS相关（P<0.001）。亚组分析表明，在仅骨转移模式中，相对于保乳手术（BCS），接受乳房切除术的患者预后较差，生存最差的是非手术患者（BCSS：乳房切除术：HR=1.35；95%CI=1.15-1.60；非手术：2.42；2.08-2.82；OS：乳房切除术：1.44；1.23-1.68；非手术：2.40；2.08-2.78）。此外，BCS患者与接受乳房重建的患者之间未观察到生存差异（BCSS：HR=1.10；95%CI=0.85-1.43；OS：1.11；0.86-1.44）。此外，在内脏转移模式中，接受BCS的患者与接受乳房切除术的患者以及接受乳房重建的患者的BCSS相似，而非手术患者的生存较差（乳房切除术：HR=1.04；95%CI=0.92-1.18；重建：0.86；0.69-1.06；非手术：1.83；1.63-2.05）。建立了两个不同转移模式的竞争风险列线图，以全面预测患者的生存情况。校准曲线表明模型具有良好的一致性。此外，训练集和验证集的AUC值在0.70-0.80范围内，显示出良好的特异性和敏感性。
手术实施与IV期BC患者较低的BCSD概率相关。我们的列线图可以对原发性肿瘤切除术后BCSD的累积发病率提供相对准确和个体化的预测。
