Individualized Prediction of Survival Benefit From Locoregional Surgical Treatment for Patients With Metastatic Breast Cancer

Abstract

Objective: Recently, performing locoregional surgical treatment still remains debatable in patients with metastatic breast cancer (MBC). Current study aimed to develop prognostic nomograms for predicting the long-term survival in MBC patients with or without surgical intervention, thereby assisting clinicians in making individualized choice. Methods: The training set included 5173 patients who were diagnosed with MBC in 2010-2013 from the Surveillance, Epidemiology, and End Results Program, while the validation set comprised 2924 patients diagnosed in 2014-2015. Multivariant Cox hazard model was applied to determine the independent risk factors for overall survival (OS) and breast cancer specific survival (BCSS). Then, individualized pre- and postoperative nomograms for predicting 1- or 3-year survival probabilities were constructed accordingly. Internal and external validations were conducted to determine the accuracy of these nomograms by calculating concordance index (C-index) and plotting calibration curves. Results: The survival analysis indicated that surgical management conferred improved OS and BCSS in patients with metastatic breast cancer. Age, T stage, grade, distant metastatic site, ER, PR and HER2 status, radiation, and chemotherapy were independent risk factors for OS and BCSS both in surgery and non-surgery group. All these factors were subsequently incorporated into the nomogram which showed acceptable predictive capabilities with C-index range of 0.65-0.80 both in training set and external validation set. In addition, a preoperative nomogram incorporating variables capable of being determined before surgery was also built with C-index above 0.70 both in training and validation set. Conclusion: Surgical management in patients with metastatic breast cancer suggests a potential survival advantage. In addition, these well-validated pre- and postoperative nomograms may provide a useful tool to assist clinicians in treatment decision-making and in evaluating patients' long term prognosis.

Keywords: SEER program; clinic utility; metastatic breast cancer; nomogram; prognosis.

Figure 1

Flowchart of data selection. SEER, Surveillance, Epidemiology, and End Results Program.

Figure 2

(A) Overall survival (OS) and (B) breast cancer specific survival (BCSS) curves plotted by Kaplan-Meier method for patients received surgical treatment or not.

Figure 3

Nomogram for predicting 1- and 3-year OS and BCSS in patients with metastatic breast cancer. (A) OS for patients who undergo surgical treatment. (B) BCSS for patients who undergo surgical treatment. (C) OS for patients who does not undergo surgical treatment. (D) BCSS for patients who does not undergo surgical treatment.

Figure 4

Preoperative nomogram for predicting 1- and 3-year OS (A) and BCSS (B) in patients with metastatic breast cancer who are candidate for surgical treatment.