Abstract
ObjectiveThe prognosis of patients with breast cancer liver metastasis (BCLM) was poor. We aimed at constructing a nomogram to predict overall survival (OS) for BCLM patients using the SEER (Surveillance Epidemiology and End Results) database, thus choosing an optimized therapeutic regimen to treat.MethodsWe identified 1173 patients with BCLM from the SEER database and randomly divided them into training (n=824) and testing (n=349) cohorts. The Cox proportional hazards model was applied to identify independent prognostic factors for BCLM, based on which a nomogram was constructed to predict 1-, 2-, and 3-year OS. Its discrimination and calibration were evaluated by the Concordance index (C-index) and calibration plots, while the accuracy and benefits were assessed by comparing it to AJCC-TNM staging system using the decision curve analysis (DCA). Kaplan-Meier survival analyses were applied to test the clinical utility of the risk stratification system.ResultsGrade, marital status, surgery, radiation therapy, chemotherapy, CS tumor size, tumor subtypes, bone metastatic, brain metastatic, and lung metastatic were identified to be independent prognostic factors of OS. In comparison with the AJCC-TNM staging system, an improved C-index was obtained (training group: 0.701 vs. 0.557, validation group: 0.634 vs. 0.557). The calibration curves were consistent between nomogram-predicted survival probability and actual survival probability. Additionally, the DCA curves yielded larger net benefits than the AJCC-TNM staging system. Finally, the risk stratification system can significantly distinguish the ones with different survival risk based on the different molecular subtypes.ConclusionWe have successfully built an effective nomogram and risk stratification system to predict OS in BCLM patients, which can assist clinicians in choosing the appropriate treatment strategies for individual BCLM patients.
Highlights
Breast cancer is the most common cancer in women around the world and the second leading cause of cancer death after lung cancer in American women [1]
The proportion of chemotherapy-received patients was much larger than the surgery and radiation therapy, 71.8%, 31.4%, and 28.4% in the training cohort, respectively
Because these results showed excellent prediction efficiency in survival of the nomogram, we calculated total points based on the predicted score calculated by the nomogram
Summary
Breast cancer is the most common cancer in women around the world and the second leading cause of cancer death after lung cancer in American women [1]. Breast cancer can metastasize to bone, lung, liver, pleura, skin, soft tissue, etc. Breast cancer liver metastases (BCLM) are very common in the clinical treatment of breast cancer. 50% of all breast cancer will occur with metastasis and the liver represents the third most frequent site of metastasis in patients with breast cancer [3, 4]. BCLM is considered the most lethal compared with other sites of metastases (e.g., the lung, bone, or brain), with 5-year survival rates of only 3.8-12% (median survival, 4-21 months) [5]. Despite systemic chemotherapy including hormonal therapy, biological therapy, palliative therapy, and radiation having been performed, the prognoses of BCLM remains poor with a median survival of only 4.8-15 months [6, 7]. In this study, we propose to construct nomograms for predicting overall survival (OS) in patients with BCLM
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