Abstract
Luminal breast cancer constitutes a group of highly heterogeneous diseases with a sustained high risk of late recurrence. We aimed to develop comprehensive and practical nomograms to better estimate the long-term survival of luminal breast cancer.Patients with luminal breast cancer diagnosed between 1990 and 2006 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into the training (n = 87,867) and validation (n = 88,215) cohorts. The cumulative incidence function (CIF) and a competing-risks model were used to estimate the probability of breast cancer-specific survival (BCSS) and death from other causes. We integrated significant prognostic factors to build nomograms and subjected the nomograms to bootstrap internal validation and to external validation.We screened 176,082 luminal breast cancer cases. The 5- and 10-year probabilities of overall death were 0.089 and 0.202, respectively. The 5- and 10-year probabilities of breast cancer-specific mortality (BCSM) were 0.053 and 0.112, respectively. Nine independent prognostic factors for both OS and BCSS were integrated to construct the nomograms. The calibration curves for the probabilities of 5- and 10-year OS and BCSS showed excellent agreement between the nomogram prediction and actual observation. The C-indexes of the nomograms were high in both internal validation (0.732 for OS and 0.800 for BCSS) and external validation (0.731 for OS and 0.794 for BCSS).We established nomograms that accurately predict OS and BCSS for patients with luminal breast cancer. The nomograms can identify patients with higher risk of late overall mortality and BCSM, helping physicians in facilitating individualized treatment.
Highlights
Breast cancer is the most common cancer diagnosed in women, [1] and approximately 1 in 8 women living in the United States has a lifetime risk of being diagnosed with breast cancer. [2] It has been well established that these tumors are extremely heterogeneous in that their gene-expression profiles vary between individuals. [3, 4] One type of breast cancer, hormone receptor (HoR) positive, is known as luminal breast cancer and represents approximately two-thirds of all cases. [5] When comparing with triple-negative and human epidermal growth factor receptor 2 positive breast cancers, luminal breast cancer has more therapeutic options, including hormonal therapy and even targeted therapy
[6] Both the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial and the Breast International Group (BIG) 1-98 study have shown a continuing rate of recurrence, and more than half of all relapse events occurred in luminal breast cancer www.impactjournals.com/oncotarget patients even 5 years after initial treatment. [7,8,9] Luminal breast cancer consists of a group of highly heterogeneous diseases, and the prognosis of each patient is extremely variable
The entire population were collected from the Surveillance, Epidemiology, and End Results (SEER) program, containing 176,082 patients with histologically confirmed invasive breast cancer, with 87,867 patients in the training cohort and 88,215 patients in the validation cohort
Summary
Breast cancer is the most common cancer diagnosed in women, [1] and approximately 1 in 8 women living in the United States has a lifetime risk of being diagnosed with breast cancer. [2] It has been well established that these tumors are extremely heterogeneous in that their gene-expression profiles vary between individuals. [3, 4] One type of breast cancer, hormone receptor (HoR) positive, is known as luminal breast cancer and represents approximately two-thirds of all cases. [5] When comparing with triple-negative and human epidermal growth factor receptor 2 positive breast cancers, luminal breast cancer has more therapeutic options, including hormonal therapy and even targeted therapy. After receiving 5 years of adjuvant hormonal therapy, patients with luminal breast cancer still have a sustained risk of disease recurrence and death for at least 15 years after diagnosis. [7,8,9] Luminal breast cancer consists of a group of highly heterogeneous diseases, and the prognosis of each patient is extremely variable. Given the potential for a relatively long-term survival of patients with luminal breast cancer, a considerable number of patients might die from other causes. To the best of our knowledge, nomograms for predicting long-term OS and BCSS of patients with luminal breast cancer have not been reported. We aimed to develop comprehensive and practical nomograms based on a large population with long-term follow-up to better estimate the long-term OS and BCSS of luminal breast cancer patients
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