Wang Zhe, Xing Lei, Luo Xinrong, Ren Guosheng
Department of Breast Surgery, Jiulongpo People's Hospital, Chongqing, China.
Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Gland Surg. 2022 Jul;11(7):1166-1179. doi: 10.21037/gs-22-321.
Nomograms can assess the risk of clinicopathological features by quantifying the biological and clinical variables of cancer patients. However, the nomogram based on significant factors that influence the survival of breast cancer in a large population has been rarely explored. This study was to investigate the predictive effectiveness of a nomogram for the survival of patients with breast cancer.
Demographic and clinical data of 275,812 breast cancer patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All patients aged ≥20 years in this retrospective cohort study were classified as two groups in a random manner, namely the training set (n=193,069) and validation set (n=82,743). The outcomes of our study were the 3- and 5-year survival of breast cancer. The potential predictors of cancer mortality were screened by univariate and multivariable Cox regression analyses. The nomogram was conducted based on the predictors. Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curve was utilized to evaluate the performance of the nomogram.
The age at diagnosis, race, marital status, tumor size, first malignant primary indicator, American Joint Committee on Cancer (AJCC) T stage, M stage, tumor grade, and number of malignant tumors were independent predictors for the death of patients with breast cancer. The C-indexes of the training set and the validation set were 0.782 and 0.778, respectively. The area under the curve (AUC) values of the nomogram for predicting the 3- and 5-year survival of breast cancer were 0.770 and 0.756, respectively. Furthermore, the C-index values of our nomogram were 0.816, 0.775, 0.773, 0.734, and 0.750 for predicting survival in Asian, White, Hispanic, American Indian, and Black populations, respectively.
The nomogram may have predictive performance for predicting the 3- and 5-year survival of breast cancer patients, and future studies need to validate our findings.
列线图可以通过量化癌症患者的生物学和临床变量来评估临床病理特征的风险。然而，基于影响大量人群乳腺癌生存的重要因素的列线图却鲜有研究。本研究旨在探讨列线图对乳腺癌患者生存的预测效能。
从监测、流行病学和最终结果（SEER）数据库中提取275812例乳腺癌患者的人口统计学和临床数据。在这项回顾性队列研究中，所有年龄≥20岁的患者被随机分为两组，即训练集（n = 193069）和验证集（n = 82743）。本研究的结局指标是乳腺癌患者的3年和5年生存率。通过单因素和多因素Cox回归分析筛选癌症死亡的潜在预测因素。基于这些预测因素构建列线图。采用Harrell一致性指数（C指数）、受试者操作特征（ROC）曲线和校准曲线来评估列线图的性能。
诊断年龄、种族、婚姻状况、肿瘤大小、首发恶性原发指标、美国癌症联合委员会（AJCC）T分期、M分期、肿瘤分级和恶性肿瘤数量是乳腺癌患者死亡的独立预测因素。训练集和验证集的C指数分别为0.782和0.778。列线图预测乳腺癌3年和5年生存率的曲线下面积（AUC）值分别为0.770和0.756。此外，我们的列线图预测亚洲、白人、西班牙裔、美国印第安人和黑人人群生存的C指数值分别为0.816、0.775、0.773、0.734和0.750。
该列线图可能对预测乳腺癌患者的3年和5年生存率具有预测性能，未来研究需要验证我们的发现。
