Development and Evaluation of Prediction Models for Breast Cancer Prognosis

项目总结 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，使其成为 美国女性癌症死亡的第二大原因。目前，约有310万女性 在美国与乳腺癌生活在一起。尽管乳腺癌的总体预后良好，但 复发持续到患者的余生，15年复发率大于 40%。因此，对乳腺癌预后的准确预测对于制定个性化的治疗方案至关重要。 治疗，这将最大限度地提高治疗效果，免除患者不必要的治疗，并确定 对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 乳腺癌预后的模型，包括佐剂！在线，使用最广泛的预测工具 在美国，仅包括临床病理预后因素(例如，年龄、肿瘤分级和大小以及淋巴 激素受体结节 ，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，没有任何预测 已经开发了工具或模型，并在患有乳腺癌的亚洲妇女中进行了验证。在 建议研究，我们将利用上海乳腺癌生存研究的资源，很好地 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 关于生活方式因素的信息，以建立结合临床病理和 生活方式因素。将首先建立单独的预测模型，以预测5年和10年的总存活率， 基于临床病理因素的癌症特异性存活率和无病存活率 包括在辅助剂！在网上，然后扩展到纳入生活方式因素。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。 建议的研究具有成本效益、可行性，并将填补乳腺癌预后预测方面的空白。 研究。虽然生活方式因素的流行率在美国和中国可能有所不同，但我们有 我们在#年对生活方式因素和乳腺癌预后的调查中特别证明了这一点。 几项大规模研究表明，体力活动、诊断前体重指数和大豆食物摄入量之间存在关联。 乳腺癌的结果，不分国家或种族/民族。因此，所获得的知识 对建立乳腺癌预测模型具有一定的推广价值 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.