A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis
A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis
复制标题
预测新发远处转移三阴性乳腺癌患者总体生存率和手术获益的风险分层模型
DOI：
10.3389/fonc.2020.00014
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发表时间：
2020-01-24
影响因子：
4.7
通讯作者：
Shen, Kun-Wei
中科院分区：
文献类型：
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作者：
Wang, Zheng;Wang, Hui;Shen, Kun-Wei
背景和目标：本研究旨在构建一种新的模型，用于预测三阴性乳腺癌（TNBC）伴原发性远处转移患者的总生存期（OS）和手术获益。研究方法：我们收集了2010年至2016年期间发生远处转移的TNBC患者的监测、流行病学和最终结果（SEER）数据库的数据。如果有关转移状态、随访时间或临床病理信息的数据不完整，则排除患者。单变量和多变量分析用于确定重要的预后参数。通过整合这些变量，构建了预测诺模图和风险分层模型，并使用C指数和校准曲线进行评估。结果：最终确定了1，737名患者。2010年至2014年入组的患者被随机分配到两个队列，918例患者在培训队列，306例患者在验证队列I，513例患者在2015年至2016年入组，被分配到验证队列II。包括7个临床病理因素作为诺模图中的预后变量：年龄、婚姻状况、T分期、骨转移、脑转移、肝转移和肺转移。训练队列的C指数为0.72 [95%置信区间[CI] 0.68-0.76]，验证队列I为0.71（95% CI 0.68-0.74），验证队列II为0.71（95% CI 0.67-0.75）。校正图表明，基于诺模图的预测结果与重新编码的预后具有良好的一致性。进一步生成风险分层模型，以准确地将患者区分为三个预后组。在所有队列中，低、中和高风险组的中位总生存时间分别为17.0个月（95% CI 15.6-18.4）、11.0个月（95% CI 10.0-12.0）和6.0个月（95% CI 4.7-7.3）。局部区域手术改善了低危组和中危组的预后[风险比[HR] 0.49，95%CI 0.41-0.60，P < 0.0001]（HR 0.55，95% CI 0.46-0.67，P < 0.0001），而高危组无此现象（HR 0.73，95% CI 0.52-1.03，P = 0.068）。所有分层组均能从化疗中获益（低危组：HR 0.50，95% CI 0.35-0.69，P < 0.0001;中危组：HR 0.34，95% CI 0.26-0.44，P < 0.0001;高危组：HR 0.16，95% CI 0.10-0.25，P < 0.0001）。结论：构建了一个预测性列线图和风险分层模型，以评估原发性远处转移TNBC患者的预后;这些方法可能为治疗决策和进一步研究提供额外的内省、整合和改进。
Background and Aims: This research aimed to construct a novel model for predicting overall survival (OS) and surgical benefit in triple-negative breast cancer (TNBC) patients with de novo distant metastasis. Methods: We collected data from the Surveillance, Epidemiology, and End Results (SEER) database for TNBC patients with distant metastasis between 2010 and 2016. Patients were excluded if the data regarding metastatic status, follow-up time, or clinicopathological information were incomplete. Univariate and multivariate analyses were applied to identify significant prognostic parameters. By integrating these variables, a predictive nomogram and risk stratification model were constructed and assessed with C-indexes and calibration curves. Results: A total of 1,737 patients were finally identified. Patients enrolled from 2010 to 2014 were randomly assigned to two cohorts, 918 patients in the training cohort and 306 patients in the validation cohort I, and 513 patients enrolled from 2015 to 2016 were assigned to validation cohort II. Seven clinicopathological factors were included as prognostic variables in the nomogram: age, marital status, T stage, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The C-indexes were 0.72 [95% confidence interval [CI] 0.68–0.76] in the training cohort, 0.71 (95% CI 0.68–0.74) in validation cohort I and 0.71 (95% CI 0.67–0.75) in validation cohort II. Calibration plots indicated that the nomogram-based predictive outcome had good consistency with the recoded prognosis. A risk stratification model was further generated to accurately differentiate patients into three prognostic groups. In all cohorts, the median overall survival time in the low-, intermediate- and high-risk groups was 17.0 months (95% CI 15.6–18.4), 11.0 months (95% CI 10.0–12.0), and 6.0 months (95% CI 4.7–7.3), respectively. Locoregional surgery improved prognosis in both the low-risk [hazard ratio [HR] 0.49, 95% CI 0.41–0.60, P < 0.0001] and intermediate-risk groups (HR 0.55, 95% CI 0.46–0.67, P < 0.0001), but not in high-risk group (HR 0.73, 95% CI 0.52–1.03, P = 0.068). All stratified groups could prognostically benefit from chemotherapy (low-risk group: HR 0.50, 95% CI 0.35–0.69, P < 0.0001; intermediate-risk group: HR 0.34, 95% CI 0.26–0.44, P < 0.0001; and high-risk group: HR 0.16, 95% CI 0.10–0.25, P < 0.0001). Conclusion: A predictive nomogram and risk stratification model were constructed to assess prognosis in TNBC patients with de novo distant metastasis; these methods may provide additional introspection, integration and improvement for therapeutic decisions and further studies.