Abstract
Purpose Overall survival (OS) and cancer-specific survival (CSS) of luminal A breast cancer (BC) patients with bone metastasis remain poor and vary dramatically from person to person. Our goal was to build two universally applicable nomograms to accurately predict OS and CSS for luminal A patients with bone metastasis. Methods The data were collected from the Surveillance, Epidemiology, and End Results (SEER) database for luminal A BC patients with bone metastasis between 2010 and 2015. Univariate and multivariate Cox regression analyses were to assess and identify independent risk factors of OS and CSS. Integrating all significant predictors, nomograms and risk group stratification model was developed. The performance of the nomogram was validated with concordance index (C-index), calibration plots, and decision curve analyses (DCA) for discriminative ability, calibration, and clinical utility, respectively. Results 3171 luminal A BC patients with bone metastasis were included. Through univariate and multivariate Cox regression analyses, 12 variables were identified as both independent OS- and CSS-related factors, including age, race, primary site, histology grade, tumor size, surgery, brain metastasis, liver metastasis, lung metastasis, estrogen receptor status, progesterone receptor status, and insurance. Our nomograms for 1-, 3-, and 5-year survival were based on those significant prognostic factors to develop. The C-indexes of OS- and CSS-nomograms in the training cohort were 0.701 and 0.704, respectively. Similar results were obtained in the validation cohort. The calibration curves and DCA presented satisfactory calibration and clinical utility. Conclusion Two nomograms have good discrimination, calibration, and clinical utility, can accurately and effectively predict the prognosis of patients, and may benefit for clinical decision-making. In high-risk patients, more aggressive therapy and closer surveillance should be considered.
Highlights
Breast cancer (BC) is the second most diagnosed cancer (11.6% of the cancer cases), second only to lung cancer, and accounts for a quarter of all female cancer cases [1]
There is no need for informed consent in our study since the unidentified data was free from medical ethics review
Consistent with previous studies, our study suggests that age is a strong independent prognostic factor and young age is an advantageous factor for good prognosis [20, 21]
Summary
Breast cancer (BC) is the second most diagnosed cancer (11.6% of the cancer cases), second only to lung cancer, and accounts for a quarter of all female cancer cases [1]. BC is the most generally diagnosed cancer and the main cause of cancer death [1]. BCs can be divided into molecular subtypes of Triple negative, luminal A, Luminal. The main cause of death for BC patients is not the primary tumor but the occurrence of distant metastasis [4]. A population-based research including about 300,000 patients indicated that the bone metastasis (3.28%) takes the leading place in distant metastasis secondary to BC, which will develop in almost 3/4 of stage-IV BC patients [6], negatively affecting the patient’s mobility, survival expectancy, and life quality.
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