Abstract
To better understand the clinical characteristics of newly diagnosed lung metastatic breast cancer (LMBC) and quantify its prognosis, we retrieved data on patients with LMBC from the Surveillance, Epidemiology, and End Results database. Eligible patients were randomly assigned to training and validation cohorts (ratio 7:3) to establish a nomogram using the Cox proportional hazards regression model. In total, 4310 patients with LMBC were enrolled, including 52.4% (2259/4310) HR+/HER2−, 17.6% (757/4310) HR+/HER2+, 10.8% (467/4310) HR−/HER2+, and 19.2% (827/4310) HR−/HER2− subtype patients. Inclinations of lung and brain involvement in HR−/HER2+ and HR−/HER2− subgroups, liver involvement in the HER2 overexpressing subgroup, and bone involvement in the HR-positive subgroup were detected in the LMBC population. Regarding prognosis, HR+/HER2+ subtype patients presented the most favorable profile (mOS 35.0 months, 95% CI 30.1–39.9), while HR−/HER2− patients exhibited the worst (mOS 11.0 months, 95% CI, 10.0–11.9). A nomogram was developed in the training cohort and validated internally (C-index 0.70) and externally (C-index 0.71), suggestive of decent performance. This study assessed the clinical outcomes associated with molecular subtypes, metastatic patterns, and surgical intervention and provided a robust nomogram for the estimation of survival probabilities, which are promising for the management of LMBC in clinical practice.
Highlights
To better understand the clinical characteristics of newly diagnosed lung metastatic breast cancer (LMBC) and quantify its prognosis, we retrieved data on patients with LMBC from the Surveillance, Epidemiology, and End Results database
Luminal-like subtype LMBC exhibited a higher rate of bone metastasis (P < 0.0001), while the human epidermal growth factor receptor 2 (HER2) overexpression subtype, including hormone receptor (HR)+/HER2+ and HR−/HER2+, tended to be associated with a relatively higher occurrence of liver metastasis (P < 0.0001)
The newly established nomogram showed good performance for survival estimation in patients with LMBC. This is the first study to comprehensively discuss the clinical features and prognostic outcomes associated with molecular subtypes, metastatic patterns, and surgical intervention and to develop a robust prediction model for the estimation of individual prognosis of de novo metastatic breast cancer with lung involvement
Summary
To better understand the clinical characteristics of newly diagnosed lung metastatic breast cancer (LMBC) and quantify its prognosis, we retrieved data on patients with LMBC from the Surveillance, Epidemiology, and End Results database. This study assessed the clinical outcomes associated with molecular subtypes, metastatic patterns, and surgical intervention and provided a robust nomogram for the estimation of survival probabilities, which are promising for the management of LMBC in clinical practice. De novo metastatic breast cancer refers to distant metastasis at the initial diagnosis and an inferior prognosis, with a 5-year survival rate of less than 30%; patients with de novo metastatic breast cancer account for approximately 5% of the entire population[1,2] It is treatable considering the advances in novel therapeutics, de novo metastatic disease tends to be incurable and could be a therapeutic challenge in clinical practice. We conducted this study to comprehensively discuss the clinicopathological and prognostic characteristics of patients with LMBC to assess the associations between clinical outcomes and molecular subtypes, metastatic patterns, and surgical performance. We further aimed to establish a prediction model for the individual estimation of survival probabilities of patients with LMBC to provide promising evidence and reference for the introduction of individual therapeutics for patients with LMBC in clinical practice
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