Abstract
BackgroundYoung women with breast cancer are determined to present poorer survival compare with elderly patients. Therefore, identifying the clinical prognostic factors in young women with early-stage (T1-2N0-1M0) breast cancer is pivotal for surgeons to make better postoperative management.MethodsThe clinicopathological characteristics of female patients with early-stage breast cancer from the Surveillance, Epidemiology, and End Results program between Jan 2010 and Dec 2015 were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analyses were used to determine the potential risk factors of cancer-specific survival in young women with early-stage breast cancer. The nomogram was constructed and further evaluated by an internal validation cohort. The Kaplan-Meier survival curves were used to estimate cancer-specific survival probability and the cumulative incidence.ResultsSix variables including race, tumor location, grade, regional lymph node status, tumor subtype, and size were identified to be significantly associated with the prognosis of young women with early-stage breast cancer during the postoperative follow-up. A nomogram for predicting the 3-, 5- year cancer-specific survival probability in this subpopulation group was established with a favorable concordance index of 0.783, supported by an internal validation cohort with the AUC of 0.722 and 0.696 in 3-, 5- year cancer-specific survival probability, respectively.ConclusionsThe first predictive nomogram containing favorable discrimination is successfully established and validated for predicting the 3-, 5- year cancer-specific survival probability in young women with early-stage breast cancer during the postoperative follow-up. This model would help clinicians to make accurate treatment decisions in different clinical risk population.
Highlights
Breast cancer has become the most frequently diagnosed malignancy and one of the leading causes of cancer-specific death in China and around the world [1,2,3,4], with a female predominance
From the SEER database, a total of 7203 young female patients aged between 18 and 40 years old with early-stage breast cancer were included in this study and further randomized into training (5042 cases) and validating (2161 cases) cohorts at a ratio of 7:3
There were more than half of patients diagnosed with breast cancer at T2 tumor size, and approximately 40% of patients suffered from regional lymph node metastasis
Summary
Breast cancer has become the most frequently diagnosed malignancy and one of the leading causes of cancer-specific death in China and around the world [1,2,3,4], with a female predominance. The rates were stable in young female patients aged between 30-39 years because of a flattening of declines in female breast cancer [5]. According to the latest report from the American Cancer Society [5], the breast cancer incidence rate was 0.1, 5.7, and 46.6 per 100,000 population among young women aged between 15-19 years, 2029 years, and 30-39 years, respectively. Approximately 43% and 7% of young women were diagnosed at the regional or distant stage and the breast cancer-specific death reached 22% among women aged 15-39 years. Young women with breast cancer are determined to present poorer survival compare with elderly patients. Identifying the clinical prognostic factors in young women with early-stage (T1-2N0-1M0) breast cancer is pivotal for surgeons to make better postoperative management
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