Zhang Mingkun, Qin Yuan, Hou Niuniu, Ji Fuqing, Zhang Zhihao, Zhang Juliang
Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shanxi, China.
Department of General Surgery, Eastern Theater Air Force Hospital of People's Liberation Army (PLA), Nanjing, China.
Front Oncol. 2023 Jul 12;13:1156015. doi: 10.3389/fonc.2023.1156015. eCollection 2023.
We aimed at establishing a nomogram to accurately predict the overall survival (OS) of non-metastatic invasive micropapillary breast carcinoma (IMPC).
In the training cohort, data from 429 patients with non-metastatic IMPC were obtained through the Surveillance, Epidemiology, and End Results (SEER) database. Other 102 patients were enrolled at the Xijing Hospital as validation cohort. Independent risk factors affecting OS were ascertained using univariate and multivariate Cox regression. A nomogram was established to predict OS at 3, 5 and 8 years. The concordance index (C-index), the area under a receiver operating characteristic (ROC) curve and calibration curves were utilized to assess calibration, discrimination and predictive accuracy. Finally, the nomogram was utilized to stratify the risk. The OS between groups was compared through Kaplan-Meier survival curves.
The multivariate analyses revealed that race ( = 0.047), surgery ( = 0.003), positive lymph nodes ( = 0.027), T stage ( = 0.045) and estrogen receptors ( = 0.019) were independent prognostic risk factors. The C-index was 0.766 (95% CI, 0.682-0.850) in the training cohort and 0.694 (95% CI, 0.527-0.861) in the validation cohort. Furthermore, the predicted OS was consistent with actual observation. The AUCs for OS at 3, 5 and 8 years were 0.786 (95% CI: 0.656-0.916), 0.791 (95% CI: 0.669-0.912), and 0.774 (95% CI: 0.688-0.860) in the training cohort, respectively. The area under the curves (AUCs) for OS at 3, 5 and 8 years were 0.653 (95% CI: 0.498-0.808), 0.683 (95% CI: 0.546-0.820), and 0.716 (95% CI: 0.595-0.836) in the validation cohort, respectively. The Kaplan-Meier survival curves revealed a significant different OS between groups in both cohorts (<0.001).
Our novel prognostic nomogram for non-metastatic IMPC patients achieved a good level of accuracy in both cohorts and could be used to optimize the treatment based on the individual risk factors.
我们旨在建立一种列线图，以准确预测非转移性浸润性微乳头状乳腺癌（IMPC）的总生存期（OS）。
在训练队列中，通过监测、流行病学和最终结果（SEER）数据库获取了429例非转移性IMPC患者的数据。另外102例患者在西京医院入组作为验证队列。使用单因素和多因素Cox回归确定影响OS的独立危险因素。建立列线图以预测3年、5年和8年的OS。使用一致性指数（C指数）、受试者操作特征（ROC）曲线下面积和校准曲线来评估校准、区分度和预测准确性。最后，利用列线图对风险进行分层。通过Kaplan-Meier生存曲线比较各组之间的OS。
多因素分析显示，种族（=0.047）、手术（=0.003）、阳性淋巴结（=0.027）、T分期（=0.045）和雌激素受体（=0.019）是独立的预后危险因素。训练队列中的C指数为0.766（95%CI，0.682-0.850），验证队列中的C指数为0.694（95%CI，0.527-0.861）。此外，预测的OS与实际观察结果一致。训练队列中3年、5年和8年OS的曲线下面积（AUC）分别为0.786（95%CI：0.656-0.916）、0.791（95%CI：0.669-0.912）和0.774（95%CI：0.688-0.860）。验证队列中3年、5年和8年OS的曲线下面积（AUC）分别为0.653（95%CI：0.498-0.808）、0.683（95%CI：0.546-0.820）和0.716（95%CI：0.595-0.836）。Kaplan-Meier生存曲线显示，两个队列中各组之间的OS存在显著差异（<0.001）。
我们为非转移性IMPC患者建立的新型预后列线图在两个队列中均达到了良好的准确性水平，可用于根据个体危险因素优化治疗。
