Development and Evaluation of Prediction Models for Breast Cancer Prognosis

描述（由申请人提供）：八分之一的美国妇女将在她的一生中被诊断患有乳腺癌，使其成为美国妇女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，但复发的风险在患者的余生中持续存在，15年复发率大于40%。因此，准确预测乳腺癌的结果对于制定个性化治疗至关重要，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进行预防性干预。然而，现有的乳腺癌预后预测工具和模型，包括Adjuvant！在线是美国使用最广泛的预测工具，仅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子，如肥胖、体重增加和诊断后体力活动。此外，尚未在亚洲乳腺癌女性中开发和验证预测工具或模型。在拟议的研究中，我们将利用上海乳腺癌生存研究的资源，这是一项对5，042名乳腺癌幸存者进行的基于人群的前瞻性队列研究，详细了解生活方式因素，以建立结合临床病理和生活方式因素的预测模型。根据Adjuvant！在线，然后扩展到包括生活方式因素。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。该研究具有成本效益高、可行性强的特点，将填补乳腺癌预后预测研究的空白。虽然生活方式因素在美国和中国的流行率可能不同，但我们在几项大规模研究中对生活方式因素和乳腺癌结局的调查中特别证明了这一点， 诊断前BMI和大豆食物摄入量与乳腺癌结局相关，无论国家或种族/民族如何。因此，从拟议的研究中获得的知识应该是可推广的，为其他种族和民族的乳腺癌患者建立预测模型。

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.