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. 2024 Dec 31;24(1):675.
doi: 10.1186/s12905-024-03526-w.

Development of prognostic models for HER2-positive metastatic breast cancer in females: a retrospective population-based study

Yan Chen #  1   2 , Yu Qiu #  1   2 , Haoyang Shen  1   2 , Shuixin Yan  1   2 , Jiadi Li  1   2 , Weizhu Wu  3
Affiliations

Development of prognostic models for HER2-positive metastatic breast cancer in females: a retrospective population-based study

Yan Chen et al. BMC Womens Health. .

Abstract

Background: This study aimed to construct, evaluate, and validate nomograms for breast cancer-specific survival (BCSS) and overall survival (OS) prediction in patients with HER2- overexpressing (HER2+) metastatic breast cancer (MBC).

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to select female patients diagnosed with HER2 + MBC between 2010 and 2015. These patients were distributed into training and validation groups (7:3 ratio). Variables were screened using univariate and multivariate Cox regression analyses, and BCSS and OS nomograms were constructed to determine one-, three-, and five-year survival probabilities. The nomograms were evaluated and validated using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Stratification was evaluated using Kaplan-Meier curves and log-rank tests based on optimal total score cut-off values. We published web-based versions of these nomograms for clinical use.

Results: A total of 2,151 eligible patients were randomized into training (n = 1,505) and validation (n = 646) groups. Independent prognostic factors of BCSS and OS included: age; marital status; race; oestrogen receptor status; surgery; chemotherapy; and bone, brain, liver, and lung metastases. The C-indices for the BCSS and OS training groups were 0.707 and 0.702, respectively. The ROC, calibration, and decision curves demonstrated the strength of the nomograms. According to cut-off values, patients were categorized into low-, intermediate-, and high-risk groups, with significant differences in survival outcomes between them.

Conclusion: We constructed predictive nomograms and stratified risk to assess the prognosis of patients with HER2 + MBC, which could help inform therapeutic decisions.

Trial registration: Not applicable.

Keywords: Breast cancer-specific survival; HER2-positive breast cancer; Metastatic; Nomogram; Overall survival; SEER database.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Our study was approved by the Ethics Review Board of The Affiliated Lihuili Hospital, Ningbo University, Ningbo (registration number: KY2024ML045). Informed consent was not required as the data were collected from a publicly available repository. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of patient selection
Fig. 2
Fig. 2
Nomograms for predicting survival in patients with HER2 + MBC. The nomograms for predicting one-, three-, and five-year BCSS (a) and OS (b). HER2 + MBC, human epidermal growth factor receptor 2-overexpressing metastatic breast cancer; BCSS, breast cancer-specific survival; OS, overall survival
Fig. 3
Fig. 3
Time-dependent ROC curves of the nomograms. ROC curves of the nomogram for predicting one-, three-, and five-year BCSS in the training group (a) and validation group (b). ROC curves of the nomogram for predicting one-, three-, and five-year OS in the training group (c) and validation group (d). ROC, receiver operating characteristic; BCSS, breast cancer-specific survival; OS, overall survival
Fig. 4
Fig. 4
Calibration curves of the nomograms. Calibration curves for predicting one- (a, d), three- (b, e) and five-year (c, f) BCSS in the training and validation groups, respectively. Calibration curves for predicting one- (g, j), three- (h, k) and five-year (i, l) OS in the training and validation groups, respectively. BCSS, breast cancer-specific survival; OS, overall survival
Fig. 5
Fig. 5
DCA of the nomograms. DCA of the nomogram for predicting one- (a, d), three- (b, e) and five-year (c, f) BCSS in the training and validation groups, respectively. DCA of the nomogram predicting one- (g, j), three- (h, k) and five-year (i, l) OS in the training group and validation group, respectively. DCA, decision curve analysis; BCSS, breast cancer-specific survival; OS, overall survival
Fig. 6
Fig. 6
The optimal cut-off values for the nomograms. Optimal cut-off values for the patients’ total scores based on the BCSS and OS nomograms using X-tile analysis (a, c). The histograms for describing the distribution of patients based on the cut-off values (b, d). BCSS, breast cancer-specific survival; OS, overall survival
Fig. 7
Fig. 7
Kaplan–Meier survival curves after risk stratification. Kaplan–Meier survival curves of low-, intermediate-, and high-risk groups for the BCSS nomogram in the training (a) and validation groups (b). Kaplan–Meier survival curves of low-, intermediate-, and high-risk groups for the OS nomogram in the training (c) and validation groups (d). BCSS, breast cancer-specific survival; OS, overall survival
Fig. 8
Fig. 8
A screenshot of the Web-based dynamic nomograms. The nomograms for BCSS (a) and OS (b) in patients with HER2 + MBC. HER2 + MBC, human epidermal growth factor receptor 2-overexpressing metastatic breast cancer; BCSS, breast cancer-specific survival; OS, overall survival
See this image and copyright information in PMC

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