Clinical Features and Serological Markers Risk Model Predicts Overall Survival in Patients Undergoing Breast Cancer and Bone Metastasis Surgeries

Haochen Mou; Zhan Wang; Wenkan Zhang; Guoqi Li; Hao Zhou; Eloy Yinwang; Fangqian Wang; Hangxiang Sun; Yucheng Xue; Zenan Wang; Tao Chen; Xupeng Chai; Hao Qu; Peng Lin; Wangsiyuan Teng; Binghao Li; Zhaoming Ye

doi:10.3389/fonc.2021.693689

Clinical Features and Serological Markers Risk Model Predicts Overall Survival in Patients Undergoing Breast Cancer and Bone Metastasis Surgeries

Front Oncol. 2021 Sep 17:11:693689. doi: 10.3389/fonc.2021.693689. eCollection 2021.

Authors

Haochen Mou^{1

2

3}, Zhan Wang^{1

2

3}, Wenkan Zhang^{1

2

3}, Guoqi Li^{1

2

3}, Hao Zhou^{1

2

3}, Eloy Yinwang^{1

2

3}, Fangqian Wang^{1

2

3}, Hangxiang Sun^{1

2

3}, Yucheng Xue^{1

2

3}, Zenan Wang^{1

2

3}, Tao Chen^{1

2

3}, Xupeng Chai^{1

2

3}, Hao Qu^{1

2

3}, Peng Lin^{1

2

3}, Wangsiyuan Teng^{1

2

3}, Binghao Li^{1

2

3}, Zhaoming Ye^{1

2

3}

Affiliations

¹ Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
³ Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.

Abstract

Background: Surgical therapy of breast cancer and bone metastasis can effectively improve the prognosis of breast cancer. However, after the first operation, the relationship between preoperative indicators and outcomes in patients who underwent metastatic bone surgery remained to be studied. Purpose 1. Recognize clinical and laboratory prognosis factors available to clinical doctors before the operation for bone metastatic breast cancer patients. 2. Develop a risk prediction model for 3-year postoperative survival in patients with breast cancer bone metastasis.

Methods: From 2014 to 2020, patients who suffered from breast cancer bone metastasis and received therapeutic procedures in our institution were included for analyses (n=145). For patients who underwent both breast cancer radical surgery and bone metastasis surgery, comprehensive datasets of the parameters of interest (clinical features, laboratory factors, and patient prognoses) were collected (n=69). We performed Multivariate Cox regression to identify factors that were associated with postoperative outcome. 3-year survival prediction model and nomograms were established by 100 bootstrapping. Its benefit was evaluated by calibration plot, C-index, and decision curve analysis. The Surveillance, Epidemiology, and End Results database was also used for external validation.

Results: Radiotherapy for primary cancer, pathological type of metastatic breast cancer, lymph node metastasis, elevated serum alkaline phosphatase, lactate dehydrogenase were associated with postoperative prognosis. Pathological types of metastatic breast cancer, multiple bone metastasis, organ metastases, and elevated serum lactate dehydrogenase were associated with 3-year survival. Then those significant variables and serum alkaline phosphatase counts were integrated to construct nomograms for 3-year survival. The C-statistic of the established predictive model was 0.83. The calibration plot presents a graphical representation of calibration. In the decision curve analysis, the benefits are higher than those of the extreme curve. The receiver operating characteristic of the external validation of the model was 0.82, indicating a favored fitting degree of the two models.

Conclusion: Our study suggests that several clinical features and serological markers can predict the overall survival among the patients who are about to receive bone metastasis surgery after breast cancer surgery. The model can guide the preoperative evaluation and clinical decision-making for patients. Level of evidence Level III, prognostic study.

Keywords: Cox regression; bone metastasis; breast cancer; nomogram; prognosis; surgeries.