Abstract
BackgroundThe role of surgery for the primary tumor in breast cancer patients with bone metastases (BM) remains unclear. The purpose of this study was to determine the impact of surgery for the primary tumor in breast cancer patients with BM and to develop prognostic nomograms to predict the overall survival (OS) of breast cancer patients with BM.MethodsA total of 3956 breast cancer patients with BM from the Surveillance, Epidemiology, and End Results database between 2010 and 2016 were included. Propensity score matching (PSM) was used to eliminate the bias between the surgery and non-surgery groups. The Kaplan-Meier analysis and the log-rank test were performed to compare the OS between two groups. Cox proportional risk regression models were used to identify independent prognostic factors. Two nomograms were constructed for predicting the OS of patients in the surgery and non-surgery groups, respectively. In addition, calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the performance of nomograms.ResultThe survival analysis showed that the surgery of the primary tumor significantly improved the OS for breast cancer patients with BM. Based on independent prognostic factors, separate nomograms were constructed for the surgery and non-surgery groups. The calibration and ROC curves of these nomograms indicated that both two models have high predictive accuracy, with the area under the curve values ≥0.700 on both the training and validation cohorts. Moreover, DCA showed that nomograms have strong clinical utility. Based on the results of the X-tile analysis, all patients were classified in the low-risk-of-death subgroup had a better prognosis.ConclusionThe surgery of the primary tumor may provide survival benefits for breast cancer patients with BM. Furthermore, these prognostic nomograms we constructed may be used as a tool to accurately assess the long-term prognosis of patients and help clinicians to develop individualized treatment strategies.
Highlights
Despite rapid advances in endocrine and targeted therapy in recent years, breast cancer is still one of the leading causes of cancer death in women [1]
The surgery of the primary tumor may provide survival benefits for breast cancer patients with bone metastases (BM). These prognostic nomograms we constructed may be used as a tool to accurately assess the longterm prognosis of patients and help clinicians to develop individualized treatment strategies
Baseline characteristics of breast cancer patients with BM before and after Propensity score matching (PSM) The workflow of our study is illustrated in the Fig. 1
Summary
Despite rapid advances in endocrine and targeted therapy in recent years, breast cancer is still one of the leading causes of cancer death in women [1]. BM often results in skeletal-related events, including spinal cord compression, pathological fractures, hypercalcemia, and severe pain [4]. These complications negatively affect patients’ mobility and mental status, with significant reductions in their quality of life [5, 6]. It is well known that surgery is a common means of treating early-stage breast cancer. Palliative treatments, such as chemotherapy, endocrine therapy, and targeted therapy, are used to improve survival, control tumor burden, reduce cancer-related symptoms and maintain quality of life for breast cancer patients with BM [7]. The purpose of this study was to determine the impact of surgery for the primary tumor in breast cancer patients with BM and to develop prognostic nomograms to predict the overall survival (OS) of breast cancer patients with BM
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