Wang Ziqiang, Wang Tingting, Xie Yangyang, Li Xiaowen, Du Danwei, Li Rongguo
The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311000, China.
The Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China.
Cancer Epidemiol. 2025 Aug;97:102853. doi: 10.1016/j.canep.2025.102853. Epub 2025 May 27.
Triple-negative breast cancer (TNBC) is an aggressive subtype with poor outcomes, especially in elderly patients. While chemotherapy is the main systemic treatment, its survival benefits for Patients with TNBC aged ≥ 70 years remain unclear due to comorbidities and treatment intolerance. This study assessed the impact of adjuvant chemotherapy on survival outcomes using competing risk analysis.
A cohort of 4855 elderly Patients with TNBC (≥70 years) was extracted from the SEER database (2010-2016). Propensity score matching (PSM) balanced baseline characteristics between chemotherapy and non-chemotherapy groups. Survival analyses were performed both in the unmatched cohort and in the matched cohort after PSM. For the construction of the nomogram, the full cohort was randomly divided into a training set (70 %) and a validation set (30 %) for internal validation. Overall survival (OS), breast cancer-specific survival (BCSS), and competing risks of breast cancer-specific death (BCSD) and other-cause death (OCD) were analyzed using Kaplan-Meier and Fine-Gray models. A nomogram was developed to predict individualized survival outcomes.
The median follow-up time was 62 months, during which 991 BCSD events and 1120 OCD events were recorded. After PSM, the 5-year OS rate was 74.2 % in the chemotherapy group and 62.4 % in the non-chemotherapy group (p < 0.05). After PSM, chemotherapy significantly improved OS (p < 0.05) but did not reduce 5-year BCSD (17.42 % vs. 18.47 %, p = 0.659). However, chemotherapy decreased 5-year OCD (9.39 % vs. 17.54 %, p < 0.001). In the full cohort training set, independent predictors of BCSD included tumor grade, radiation therapy, T category, and N category. The nomogram showed high accuracy (AUC: 1-year = 0.822, 3-year = 0.773, 5-year = 0.745) and excellent calibration.
Adjuvant chemotherapy significantly was associated with OCD, indirectly improving OS, but has limited direct impact on BCSD in elderly Patients with TNBC. Competing risk analysis highlights the importance of individualized treatment strategies. The validated nomogram provides a practical tool for precision medicine. Future research should explore biological mechanisms and validate these findings in multi-regional cohorts.
三阴性乳腺癌（TNBC）是一种侵袭性亚型，预后较差，尤其是在老年患者中。虽然化疗是主要的全身治疗方法，但由于合并症和治疗不耐受，其对年龄≥70岁的TNBC患者的生存益处仍不明确。本研究使用竞争风险分析评估辅助化疗对生存结局的影响。
从SEER数据库（2010 - 2016年）中提取了4855例老年TNBC患者（≥70岁）的队列。倾向评分匹配（PSM）平衡了化疗组和非化疗组之间的基线特征。在未匹配队列和PSM后的匹配队列中均进行了生存分析。为构建列线图，将整个队列随机分为训练集（70%）和验证集（30%）进行内部验证。使用Kaplan - Meier和Fine - Gray模型分析总生存期（OS）、乳腺癌特异性生存期（BCSS）以及乳腺癌特异性死亡（BCSD）和其他原因死亡（OCD）的竞争风险。开发了一个列线图来预测个体化生存结局。
中位随访时间为62个月，在此期间记录了991例BCSD事件和1120例OCD事件。PSM后，化疗组的5年OS率为74.2%，非化疗组为62.4%（p < 0.05）。PSM后，化疗显著改善了OS（p < 0.05），但未降低5年BCSD（17.42%对18.47%，p = 0.659）。然而，化疗降低了5年OCD（9.39%对17.54%，p < 0.001）。在整个队列训练集中，BCSD的独立预测因素包括肿瘤分级、放疗、T分期和N分期。列线图显示出高准确性（AUC：1年 = 0.822，3年 = 0.773，5年 = 0.745）和良好的校准。
辅助化疗与OCD显著相关，间接改善了OS，但对老年TNBC患者的BCSD直接影响有限。竞争风险分析突出了个体化治疗策略的重要性。经过验证的列线图为精准医学提供了一个实用工具。未来的研究应探索生物学机制，并在多地区队列中验证这些发现。
