Abstract
BackgroundPatients with early‐stage breast cancer (BC) live long but have competing comorbidities. This study aimed to estimate the effect of cancer and other causes of death in patients with early‐stage BC and further quantify the survival differences.Materials and methodsData of patients diagnosed with BC between 2010 and 2016 were collected from the Surveillance, Epidemiology, and End Results database. The cumulative incidence function for breast cancer–specific mortality (BCSM) and other cause‐specific mortality (OCSM) was estimated, and the differences were tested using the Gray test. The nomogram for estimating 3‐, 4‐, and 5‐year overall survival (OS), breast cancer–specific survival, and other cause‐specific survival was established based on Cox regression analysis and Fine and Gray competing risk analysis. The discriminative ability, calibration, and precision of the nomogram were evaluated and compared using C statistics, calibration plots, and area under the receiver operating characteristic curve.ResultsA total of 196 304 eligible patients with early‐stage BC were identified in this study. Of these, 12 417 (6.3%) patients died: 5628 (45.3%) due to BC and 6789 (54.7%) due to other causes. Five validated variables were incorporated to develop the prognostic nomogram: age, grade, tumor size, subtype, and surgery of primary site (Figure 3). Age was a strong predictive factor, which was more obvious in OCSM. The effect of surgery was more prominent in BCSM. Increased tumor size was correlated with OS and BCSM and slightly correlated with OCSM. Grade and subtype differences were more predominant in BCSM than in OCSM. The established nomogram was well calibrated and displayed good discrimination.ConclusionsWe evaluate OS and competing risks of death in patients with early‐stage BC, establishing the first comprehensive prognostic nomogram.
Highlights
Breast cancer (BC) is the most common malignant tumor among women and the main cause of cancerspecific death, with 268600 estimated new cases and 41700 estimated deaths in 2019 in the the United States of America (USA) [1]
Nomogram for estimating 3, 4, and 5-year overall survival, cancer-specific survival and other-cause-specific survival was established based on Cox regression analysis and Fine and Gray’s competing risk analysis
Small tumors were prevailing in earlystage breast cancer (BC) patients. 62.7% of the tumor sizes were smaller than 2 centimeter and only 2.8% of tumors were larger than 5cm
Summary
Breast cancer (BC) is the most common malignant tumor among women and the main cause of cancerspecific death, with 268600 estimated new cases and 41700 estimated deaths in 2019 in the USA [1]. Traditional Cox regression model may be inappropriate, because in this model, the competing events are regarded as censoring and the cancer-specific mortalities may be overestimated [10,11,12]. In this situation, the Fine and Gray model [11, 13] which takes into account the censoring is recommended. We performed a retrospective competing risk analysis and built a comprehensive nomogram to fully evaluate the OS, cancer-specific survival (CSS) and other-cause-specific survival (OCSS) in a large population of early stage BC
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