Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer
Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer
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DOI：
10.3390/cancers12082103
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发表时间：
2020-08-01
期刊：
影响因子：
5.2
通讯作者：
Kwon, Jeanny
中科院分区：
文献类型：
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作者：
Kim, Byoung Hyuck;Kim, Suzy;Kwon, Jeanny
目的：局部区域治疗已越来越多地采用转移性乳腺癌在介绍。本研究旨在开发一个个性化的计算器，以预测术后放疗（PORT）的手术切除原发性IV期乳腺癌患者的利益。方法和材料：我们检索了2010年至2014年期间诊断为IV期乳腺癌的患者的监测，流行病学和最终结果（SEER）数据库。在应用排除标准后，共有4473例患者被纳入分析。倾向评分匹配用于平衡患者的个体特征。在确定了重要的预测因子后，使用多变量回归模型开发了列线图，并进行了内部验证。然后使用拟合的生存预测模型构建基于网络的计算器。结果如下：中位随访时间为34个月，单纯手术组的3年总生存率（OS）为54.1%，手术+ PORT组为63.5%（p< 0.001）。倾向评分匹配后，PORT的生存获益得以维持（p< 0.001）。预后变量的相互作用检验发现PORT与脑转移的存在之间存在显著的相互作用（p= 0.001），PORT与激素受体表达之间存在显著的相互作用（p= 0.018）。在审查各种模型的性能后，采用对数正态分布生存模型，C指数为0.695。校准图验证了预测的生存率与实际OS率密切相关。构建了一个基于网络的生存计算器，以根据PORT提供个体化的生存估计。结论：PORT显著提高了OS率，但个体获益受多种因素影响。我们成功地开发了一个诺模图和基于网络的计算器，根据PORT预测手术切除的原发IV期乳腺癌患者的预后。这些工具有望在临床实践和相关试验的设计中发挥作用。
Purpose: Locoregional treatment has been increasingly adopted for metastatic breast cancer at presentation. This study aims to develop an individualized calculator to predict the benefit of postoperative radiotherapy (PORT) for patients with surgically resected de novo stage IV breast cancer. Methods and Materials: We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with stage IV breast cancer between 2010 and 2014. After applying exclusion criteria, a total of 4473 patients were included in the analysis. Propensity score matching was used to balance the individual characteristics of the patients. After identifying the significant prognosticators, a nomogram was developed using multivariate regression models and internally validated. A web-based calculator was then constructed using a fitted survival prediction model. Results: With a median follow-up of 34 months, the three-year overall survival (OS) rates were 54.1% in the surgery alone group and 63.5% in the surgery + PORT group (p< 0.001). The survival benefit of PORT was maintained after propensity score matching (p< 0.001). Interaction testing of the prognostic variables found significant interactions between PORT and the presence of brain metastasis (p= 0.001), and between PORT and hormonal receptor expression (p= 0.018). After reviewing the performance of various models, a log-normal distributed survival model was adopted, with a C-index of 0.695. A calibration plot verified that the predicted survival rates were strongly correlated with the actual OS rates. A web-based survival calculator was constructed to provide individualized estimates of survival according to PORT. Conclusion: PORT significantly improved OS rates, though the individual benefit was affected by a number of factors. We successfully developed a nomogram and web-based calculator that predicted the prognosis according to PORT in patients with surgically resected de novo stage IV breast cancer. These tools are expected to be useful in clinical practice and in the design of related trials.