Nomogram for predicting outcomes in elderly women with mucinous breast cancer: A retrospective study combined with external validation in southwest China

IF 1.5 Q4 ONCOLOGY
Cancer reports Pub Date : 2024-07-25 DOI:10.1002/cnr2.2112
Zhaoxia Zhang, Chenghao Zhanghuang, Qian Cai, Guangye Song, Quan Wang, Yue Tang, Hongbo Li
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引用次数: 0

Abstract

Objective

Mucinous breast cancer (MBC) is a kind of breast cancer (BC), which is rare in clinic, mainly for women, because of the low incidence rate, so there is no unified standard treatment protocol. Elderly patients have a poor prognosis due to their combined comorbidities. This study aims to investigate the effect of surgery and chemoradiotherapy on the prognosis of elderly female MBC patients and construct nomograms for predicting the OS and CSS in elderly female MBC patients.

Methods

Data for female MBC patients over 65 years are obtained from the Surveillance, Epidemiology and End Results (SEER) database, patients were divided into two groups: the training set and the validation set. External validation data of the prediction model were provided by Kunming Hospital of Traditional Chinese Medicine. We used Cox regression modeling, which was used to identify independent risk factors affecting patient prognosis. After avoiding confounding bias according to the multifactorial Cox regression model, we used these screened statistically significant results to construct column-line plots. The performance of the model was tested using the consistency index (c-index), the calibration curve, and the area under the operating characteristic curve of the receiver (AUC). Subsequently, we used decision curve analysis (DCA) to examine the potential clinical value of our nomograms.

Results

A total of 8103 elderly MBC female patients were extracted from the database SEER and were assigned to the training and validation set, randomly. A total of 83 patients from Kunming Hospital of Traditional Chinese Medicine were used in the external verification set. After multifactorial Cox regression analysis, we found that age, race, T-stage, M-stage, surgical approach, radiotherapy, and tumor size were independent risk factors for OS in elderly MBC patients. Similarly, independent risk factors of CSS included age, marital status, N stage, M stage, surgical approach, chemotherapy, and tumor size. The C-index for the OS training, validation, and external verification set were 0.731 (95%CI 0.715–0.747), 0.738 (95%CI 0.724–0.752), and 0.809 (95%CI 0.731–0.8874). The C-index of the training set, the validation set, and external verification set for CSS were 0.786 (95%CI 0.747–0.825), 0.776 (95%CI 0.737–0.815), and 0.84 (95%CI0.754–0.926), respectively. The AUC, calibration curves and DCA also showed good accuracy.

Conclusions

In this study, we construct a new nomogram to predict the prognosis of elderly patients with MBC. The nomograms have undergone internal and external validation and have been confirmed to have good clinical applicability. At the same time, we found that for elderly female MBC patients, surgery and radiotherapy significantly benefit their survival, but chemotherapy is not conducive to patient survival.

Abstract Image

预测老年粘液腺癌妇女预后的提名图:在中国西南地区进行的一项结合外部验证的回顾性研究。
目的:黏液性乳腺癌(MBC)是乳腺癌(BC)的一种,在临床上较为少见,以女性患者为主,由于发病率低,目前尚无统一的标准治疗方案。老年患者由于合并多种疾病,预后较差。本研究旨在探讨手术和化疗放疗对老年女性 MBC 患者预后的影响,并构建预测老年女性 MBC 患者 OS 和 CSS 的提名图:65岁以上女性MBC患者的数据来自监测、流行病学和最终结果(SEER)数据库,患者分为两组:训练集和验证集。预测模型的外部验证数据由昆明市中医医院提供。我们使用 Cox 回归模型来确定影响患者预后的独立风险因素。在根据多因素 Cox 回归模型避免混杂偏差后,我们利用这些筛选出的具有统计学意义的结果构建了柱状线图。我们使用一致性指数(c-index)、校准曲线和接收器工作特征曲线下面积(AUC)检验了模型的性能。随后,我们使用决策曲线分析法(DCA)检验了提名图的潜在临床价值:结果:我们从 SEER 数据库中提取了 8103 例老年 MBC 女性患者,随机分配到训练集和验证集。昆明市中医院共有 83 名患者被纳入外部验证集。经过多因素Cox回归分析,我们发现年龄、种族、T期、M期、手术方式、放疗和肿瘤大小是老年MBC患者OS的独立危险因素。同样,CSS的独立危险因素包括年龄、婚姻状况、N期、M期、手术方式、化疗和肿瘤大小。OS训练集、验证集和外部验证集的C指数分别为0.731(95%CI 0.715-0.747)、0.738(95%CI 0.724-0.752)和0.809(95%CI 0.731-0.8874)。CSS的训练集、验证集和外部验证集的C指数分别为0.786(95%CI 0.747-0.825)、0.776(95%CI 0.737-0.815)和0.84(95%CI0.754-0.926)。AUC、校准曲线和 DCA 也显示出良好的准确性:在这项研究中,我们构建了一个新的提名图来预测老年 MBC 患者的预后。提名图经过了内部和外部验证,被证实具有良好的临床适用性。同时,我们还发现,对于老年女性 MBC 患者来说,手术和放化疗能显著提高其生存率,但化疗不利于患者的生存。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cancer reports
Cancer reports Medicine-Oncology
CiteScore
2.70
自引率
5.90%
发文量
160
审稿时长
17 weeks
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