Clinical Nomogram for Predicting Survival Outcomes in Early Mucinous Breast Cancer.

Jianfei Fu,Jianfei Fu,Ting Jiang,Ting Jiang,Lunpo Wu,Fan Wang,Zhongwu Hong,Mengjie Jiang,Mengjie Jiang,Zhongwu Hong,Shuguang Li,Shuguang Li,Dan Li,William B Coleman

doi:10.1371/journal.pone.0164921

Abstract

BackgroundThe features related to the prognosis of patients with mucinous breast cancer (MBC) remain controversial. We aimed to explore the prognostic factors of MBC and develop a nomogram for predicting survival outcomes.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was searched to identify 139611 women with resectable breast cancer from 1990 to 2007. Survival curves were generated using Kaplan-Meier methods. The 5-year and 10-year cancer-specific survival (CSS) rates were calculated using the Life-Table method. Based on Cox models, a nomogram was constructed to predict the probabilities of CSS for an individual patient. The competing risk regression model was used to analyse the specific survival of patients with MBC.ResultsThere were 136569 (97.82%) infiltrative ductal cancer (IDC) patients and 3042 (2.18%) MBC patients. Patients with MBC had less lymph node involvement, a higher frequency of well-differentiated lesions, and more estrogen receptor (ER)-positive tumors. Patients with MBC had significantly higher 5 and10-year CSS rates (98.23 and 96.03%, respectively) than patients with IDC (91.44 and 85.48%, respectively). Univariate and multivariate analyses showed that MBC was an independent factor for better prognosis. As for patients with MBC, the event of death caused by another disease exceeded the event of death caused by breast cancer. A competing risk regression model further showed that lymph node involvement, poorly differentiated grade and advanced T-classification were independent factors of poor prognosis in patients with MBC. The Nomogram can accurately predict CSS with a high C-index (0.816). Risk scores developed from the nomogram can more accurately predict the prognosis of patients with MBC (C-index = 0.789) than the traditional TNM system (C-index = 0.704, P< 0.001).ConclusionsPatients with MBC have a better prognosis than patients with IDC. Nomograms could help clinicians make more informed decisions in clinical practice. The competing risk regression model, as a more rational model, is recommended for use in the survival analysis of patients with MBC in the future.

Highlights

Breast cancer is the most common cancer in women worldwide
We aimed to explore the prognostic factors of Mucinous breast cancer (MBC) and develop a nomogram for predicting survival outcomes
Patients with MBC have a better prognosis than patients with infiltrative ductal cancer (IDC)

Summary

Introduction

Mucinous breast cancer (MBC) is a rare and special type, presenting with substantial extracellular mucin, and its incidence was reported to range from 1% to 6% for all primary breast cancers [1,2,3,4]. MBC is distinct from breast cancer, and its uniqueness should be considered in clinical practice. MBC is commonly seen in elderly, postmenopausal patients and is generally considered to have a favorable prognosis. Micro-papillary MBC is considered a special type B subgroup with poor prognosis [11]. The microsatellite instability (MSI) phenotype is remarkably rare in MBC compared with mucinous carcinomas present at other anatomical sites [12,13]. The features related to the prognosis of patients with mucinous breast cancer (MBC) remain controversial. We aimed to explore the prognostic factors of MBC and develop a nomogram for predicting survival outcomes.

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