Development and Evaluation of Prediction Models for Breast Cancer Prognosis

描述(申请人提供)：每八名美国女性中就有一名在有生之年被诊断出患有乳腺癌，这使其成为导致美国女性癌症死亡的第二大原因。目前，美国约有310万女性患有乳腺癌。尽管乳腺癌的总体预后良好，但在患者的余生中，复发的风险仍然存在，15年复发率超过40%。因此，对乳腺癌结果的准确预测对于开发个性化治疗至关重要，这将最大限度地提高治疗效果，避免患者接受不必要的治疗，并识别复发风险较高的妇女进行预防性干预。然而，现有的预测工具和模型对乳腺癌的预后，包括佐剂！Online是美国使用最广泛的预测工具，只包括临床病理预后因素(例如，年龄、肿瘤分级和大小、淋巴结、激素受体和雌激素受体状态)，而不考虑公认的生活方式预测因素，如肥胖、体重增加和确诊后的体力活动。此外，还没有开发出任何预测工具或模型，并在患有乳腺癌的亚洲女性中进行验证。在这项拟议的研究中，我们将利用上海乳腺癌生存研究的资源，建立包含临床病理和生活方式因素的预测模型。该研究以人群为基础，对5042名乳腺癌幸存者进行了前瞻性队列研究，提供了有关生活方式因素的详细信息。首先将根据包括在辅助剂中的临床病理因素，分别建立5年和10年总存活率、乳腺癌特异性存活率和无病存活率的预测模型。在网上，然后扩展到纳入生活方式因素。模型将被验证和评估预测能力，然后与现有的乳腺癌预测工具/模型进行比较。这项拟议的研究具有成本效益、可行性，并将填补BREAT癌症结果预测研究的空白。虽然生活方式因素的流行程度在美国和中国之间可能有所不同，但我们在几项大规模研究中对生活方式因素和乳腺癌后果的调查中具体证明了这一点。 无论国家或种族/民族，诊断前体重指数和大豆食物摄入量与乳腺癌预后相关。因此，本研究所获得的知识对于建立其他种族和民族乳腺癌患者的预测模型具有一定的推广性。

DESCRIPTION (provided by applicant): One in eight US women will be diagnosed with breast cancer during her lifetime, making it the second leading cause of cancer deaths among US women. Currently, there are about 3.1 million women living with breast cancer in the US. Despite the overall favorable prognosis for breast cancer, the risk of recurrence persists for the remainder of the patient's lifetime, with a 15-year recurrence rate greater than 40%. Accurate prediction of breast cancer outcomes, therefore, is essential for developing personalized treatment, which would maximize treatment efficacy, spare patients unnecessary treatment, and identify women at high risk of recurrence for preventive intervention. However, existing prediction tools and models for breast cancer prognosis, including Adjuvant! online, the most widely used prediction tool in the US, include only clinicopathological prognostic factors (e.g., age, tumor grade and size, and lymph node, hormone receptor , and estrogen receptor status), without considering well-recognized lifestyle predictors such as obesity, weight gain, and post-diagnosis physical activity. In addition, no prediction tool or models have been developed and validated among Asian women with breast cancer. In the proposed study, we will utilize the resources of the Shanghai Breast Cancer Survival Study, a well characterized, population-based prospective cohort study of 5,042 breast cancer survivors with detailed information on lifestyle factors, to build prediction models that incorporate both clinicopathological and lifestye factors. Separate prediction models will be built first for 5-and 10-year overall survival, breast cancer-specific survival, and disease-free survival based on the clinicopathological factors that are included in Adjuvant! online, and then expanded to incorporate lifestyle factors. Models will be validated and evaluated for predictive ability, then compared with existing breast cancer prediction tools/models. The proposed study is cost-efficient, feasible, and will fill gaps in breat cancer outcomes prediction research. While the prevalence of lifestyle factors may differ between the US and China, we have specifically demonstrated this in our investigations of lifestyle factors and breast cancer outcomes in several large-scale studies that physical activity, pre-diagnosis BMI, and soy food intake, are associated with breast cancer outcomes, regardless of country or race/ethnicity. Therefore, the knowledge gained from the proposed study should be generalizable for building prediction models for breast cancer patients of other racial and ethnic groups.