School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
Center for Disease Control and Prevention, Pudong New Area, Shanghai, 200136, China.
BMC Womens Health. 2022 Dec 6;22(1):498. doi: 10.1186/s12905-022-02079-0.
The incidents of second primary malignancy (SPM) is increasing among breast cancer (BC) patients with long-term progression, adversely affecting survival. The purpose of this study was to screen independent overall survival (OS) risk factors and establish nomograms to predict the survival probabilities of BC patients with SPM.
A total of 163 BC patients with SPM were recruited during 2002-2015 from a total of 50 hospitals in Shanghai, China. Two nomograms to predict survival from primary BC and SPM diagnosis were constructed based on independent factors screened from multivariable analysis. The calibration and discrimination of nomograms were calculated in the training and validation cohorts.
The overall survival rates of BC patients with SPM were 88.34%, 64.42% and 54.66% at 5, 10 and 15 years, respectively. Factors of late TNM stage of SPM (HR = 4.68, 95% CI 2.14-10.25), surgery for SPM (HR = 0.60, 95% CI 0.36-1.00), SPM in the colon and rectum (HR = 0.49, 95% CI 0.25-0.98) and thyroid (HR = 0.08, 95% CI 0.01-0.61) independently affected the OS of BC patients with SPM (p < 0.05). In addition, a longer latency (≥ 5 years) was associated with better OS from BC diagnosis (p < 0.001). Older age (≥ 56) was associated with poor OS from SPM diagnosis (p = 0.019). Two nomograms established based on the above factors had better calibration and discrimination.
The TNM stage of SPM, surgery for SPM, SPM sites, latency and age at BC diagnosis are independent factors for survival and the two nomograms may provide more personalized management for BC patients with SPM.
随着乳腺癌（BC）患者长期进展，第二原发恶性肿瘤（SPM）的发生率不断增加，对生存产生不利影响。本研究旨在筛选独立的总生存（OS）风险因素，并建立列线图预测 SPM 的 BC 患者的生存概率。
本研究共纳入了 2002 年至 2015 年期间来自中国上海 50 家医院的 163 名 SPM 的 BC 患者。基于多变量分析筛选出的独立因素，构建了预测原发性 BC 和 SPM 诊断后生存的两个列线图。在训练和验证队列中计算了列线图的校准和区分度。
SPM 的 BC 患者的总体生存率分别为 5、10 和 15 年时的 88.34%、64.42%和 54.66%。SPM 的晚期 TNM 分期（HR=4.68，95%CI 2.14-10.25）、SPM 的手术治疗（HR=0.60，95%CI 0.36-1.00）、结直肠和直肠 SPM（HR=0.49，95%CI 0.25-0.98）和甲状腺 SPM（HR=0.08，95%CI 0.01-0.61）是独立影响 BC 患者 SPM OS 的因素（p<0.05）。此外，更长的潜伏期（≥5 年）与从 BC 诊断开始的更好 OS 相关（p<0.001）。年龄较大（≥56 岁）与 SPM 诊断后的不良 OS 相关（p=0.019）。基于上述因素建立的两个列线图具有更好的校准和区分度。
SPM 的 TNM 分期、SPM 的手术治疗、SPM 部位、潜伏期和 BC 诊断时的年龄是生存的独立因素，这两个列线图可能为 SPM 的 BC 患者提供更个性化的管理。
