Abstract
ObjectiveThe study was designed to construct and validate a nomogram for predicting overall survival (OS) of male breast cancer (MBC) patients with infiltrating duct carcinoma (IDC).MethodsThe cohort was selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 1, 2004 and December 31, 2013. Univariate and multivariate Cox proportional hazard (PH) regression models were performed. A nomogram was developed based on the significant prognostic indicators of OS. The discriminatory and predictive capacities of nomogram were assessed by Harrell’s concordance index (C-index), calibration plots, area under the curve (AUC) and the decision curve analysis (DCA).ResultsThe median and maximal survival time of 1862 eligible patients were 49 and 131 months, respectively. Multivariate analysis showed that age (P < 0.0001), marital status (P = 0.002), T stage (P < 0.0001), N stage (P = 0.021), M stage (P < 0.0001), progesterone receptor (PR) (P = 0.046), human epidermal growth factor receptor-2 (HER2) (P = 0.009), and chemotherapy (P = 0.003) were independent prognostic indicators of IDC of MBC. The eight variables were then combined to construct a 3-and 5-year nomogram. The C-indexes of the nomogram were0.740 (95% confidence interval [CI] [0.709–0.771]) and 0.718 (95% CI [0.672–0.764]) for the internal validation and external validation, respectively. A better discriminatory capacity was observed in the nomogram compared with the SEER summary stage (P < 0.001) and AJCC TNM staging systems (6th edition; P < 0.001) with respect to OS prediction. Good consistency was detected between the nomogram prediction and actual findings, as indicated by calibration curves. The AUC for 3-and 5-year OS was 0.739 (95% CI [0.693–0.786]) and 0.764 (95% CI [0.725–0.803]) in the training cohort and 0.737 (95% CI [0.671–0.803]) and 0.735 (95% CI [0.678–0.793]) in the validation cohort, respectively. The DCA demonstrated that the survival nomogram was clinically useful.ConclusionsThe nomogram was able to more accurately predict 3-and 5-year OS of MBC patients with IDC histology than were existing models.
Highlights
1862 eligible Male breast cancer (MBC) patients with infiltrating duct carcinoma (IDC) type diagnosed from January 1, 2004 to December 31, 2013 were enrolled in our study
Additional irradiation was performed in 26.64% of patients, and chemotherapy was conducted in 43.66% of patients
We successfully constructed a nomogram for 3- and 5-year overall survival (OS) prediction in MBC with IDC histology, which was confirmed by the favorable discrimination and calibration in both internal and external validations
Summary
Male breast cancer (MBC) is a rare malignancy accounting for less than 1% of all male cancers and less than 1% of all patients with breast cancer (Korde et al, 2010). Due to its rare incidence, MBC data are mainly acquired from small, single-centered, retrospective research or extrapolated from randomized prospective studies or clinical experience of female breast cancer (FBC) (Giordano, Buzdar & Hortobagyi, 2002). TNM staging classification is a common tool for predicting the outcomes of patients with cancer by evaluation of tumor size and location (T), regional lymph node involvement (N), and distant metastasis (M) (Burke, 2004). TNM classification is not efficient enough to encompass cancer biology or predict the outcomes of breast cancer, especially for MBC (Park et al, 2011). Other clinical factors such as age, race, tumor location, grade, adjuvant treatments, and molecular characteristics can all influence the prognosis of MBC patients (Yalaza, Inan & Bozer, 2016). The nomogram, a simple statistical predictive tool, has been shown to compare favorably with the traditional TNM staging systems in multiple types of cancers (Dai, Jin & Wang, 2018; Fang et al, 2017; Iasonos et al, 2008; Song et al, 2018; Sternberg, 2006)
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