Development and Evaluation of Prediction Models for Breast Cancer Prognosis

项目摘要 八分之一的美国女性在其一生中将被诊断出患有乳腺癌，使其成为 美国女性癌症死亡的第二大原因。目前，约有310万妇女 乳腺癌患者在美国。尽管乳腺癌的总体预后良好， 复发持续患者的余生，15年复发率大于 百分之四十因此，准确预测乳腺癌预后对于制定个性化治疗方案至关重要。 治疗，这将最大限度地提高治疗效果，节省患者不必要的治疗，并确定 复发风险高的女性需要进行预防性干预。然而，现有的预测工具和 乳腺癌预后模型，包括佐剂！在线预测工具， 美国，仅包括临床病理学预后因素（例如，年龄、肿瘤分级和大小以及淋巴结 激素受体结 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，体重增加和诊断后的身体活动。此外，没有预测 在亚洲乳腺癌妇女中开发和验证了一种工具或模型。在 建议的研究，我们将利用上海乳腺癌生存研究的资源， 一项对5,042名乳腺癌幸存者进行的特征性、基于人群的前瞻性队列研究， 生活方式因素的信息，以建立预测模型，将临床病理学和 生活方式因素。将首先建立5年和10年总生存率的单独预测模型， 癌症特异性生存期和基于临床病理学因素的无病生存期， 包括在辅助！在线，然后扩展到包括生活方式因素。将对模型进行验证 并评估预测能力，然后与现有的乳腺癌预测工具/模型进行比较。 这项研究具有成本效益，可行性，并将填补乳腺癌预后预测的空白 research.虽然美国和中国的生活方式因素的流行程度可能不同，但我们 我们在对生活方式因素和乳腺癌结果的调查中特别证明了这一点， 几项大规模的研究表明，身体活动，诊断前BMI和大豆食品摄入量， 与乳腺癌的结果，无论国家或种族/民族。因此，获得的知识 从拟议的研究应该是可推广的乳腺癌的预测模型的建立 其他种族和民族的患者。

PROJECT SUMMARY 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 lifestyle 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 breast 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.