年轻女性乳腺癌骨转移的风险、预后因素及列线图：一项大型队列回顾性研究

Risk, Prognostic Factors and Nomograms for Bone Metastasis in Young Females with Breast Cancer: A Large Cohort Retrospective Study.

作者信息

Liu Zongtai, Xue Junling, Liu Kewen, Fan Zhiyi, Liu Dongxu, Wang Dalin

出版信息

Altern Ther Health Med. 2023 Jan;29(1):182-190.

Abstract

PURPOSE

To determine the incidence of bone metastasis (BM) in young female patients with breast cancer (BC) and develop 2 robust nomograms for BM in young female patients with BC.

METHODS

We searched and downloaded the data from young (age ≤40 years) female patients with bone cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Univariate and multivariate analyses were performed to screen the potential diagnostic variables and prognostic factors for BM. The diagnostic and prognostic nomograms were generated and evaluated by the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA).

RESULTS

A total of 13 347 young female patients with BC were identified; of these, 462 were initially diagnosed as having BM. The independent risk factors for BM in young female patients with BC were tumor size, BC subtype, American Joint Committee on Cancer (AJCC) T stage, AJCC N stage, age and marital status. The independent prognostic factors in these patients were tumor size, subtype, surgery performed, lung metastasis, liver metastasis and brain metastasis. The AUC values of the diagnostic nomogram were 0.803 (95% CI; 0.795-0.811) and 0.813 (95% CI; 0.800-0.825) in the training and validation cohorts, respectively. The time-dependent AUC values of prognostic nomogram were 0.850, 0.853, and 0.824 at 2, 3 and 4 years in the training cohort, and also >0.700 in the validation cohort. For both nomograms, the discrimination was higher than all independent variables. Calibration curve and decision curve analysis (DCA) indicated that both nomograms had favorable calibration and clinical utilization. Finally, a risk stratification system was generated and the 3 risk subgroups showed significantly distinct prognoses.

CONCLUSIONS

A total of 2 nomograms were developed to assess the risk for and in prognosis of young female patients with BC with BM (BCBM).

摘要

目的

确定年轻女性乳腺癌（BC）患者骨转移（BM）的发生率，并为年轻女性BC患者的BM制定两个可靠的列线图。

方法

我们从监测、流行病学和最终结果（SEER）数据库中搜索并下载了2010年至2015年间年龄≤40岁的年轻女性骨癌患者的数据。进行单因素和多因素分析以筛选BM的潜在诊断变量和预后因素。通过受试者操作特征（ROC）曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）生成并评估诊断和预后列线图。

结果

共识别出13347例年轻女性BC患者；其中，462例最初被诊断为BM。年轻女性BC患者BM的独立危险因素为肿瘤大小、BC亚型、美国癌症联合委员会（AJCC）T分期、AJCC N分期、年龄和婚姻状况。这些患者的独立预后因素为肿瘤大小、亚型、手术方式、肺转移、肝转移和脑转移。诊断列线图在训练队列和验证队列中的AUC值分别为0.803（95%CI；0.795-0.811）和0.813（95%CI；0.800-0.825）。预后列线图在训练队列中2年、3年和4年的时间依赖性AUC值分别为0.850、0.853和0.824，在验证队列中也>0.700。对于这两个列线图，其区分度均高于所有独立变量。校准曲线和决策曲线分析（DCA）表明这两个列线图均具有良好的校准和临床实用性。最后，生成了一个风险分层系统，3个风险亚组显示出明显不同的预后。