Survival analysis and nomogram for early-stage occult breast cancer with positive lymph nodes based on the SEER database

Xiaochu Man; Han Xu; Hongxia Wang; Jiuda Zhao; Xuesong Chen; Sha Yin; Qiaorui Tan; Jie Huang; Shujuan Sun; Dongdong Zhou; Fangchao Zheng; Tong Liu; Lihua Song; Baoxuan Zhang; Na Li; Huihui Li

doi:10.21037/atm-22-5701

Survival analysis and nomogram for early-stage occult breast cancer with positive lymph nodes based on the SEER database

Ann Transl Med. 2022 Dec;10(24):1351. doi: 10.21037/atm-22-5701.

Authors

Xiaochu Man¹, Han Xu¹, Hongxia Wang², Jiuda Zhao³, Xuesong Chen⁴, Sha Yin¹, Qiaorui Tan¹, Jie Huang¹, Shujuan Sun¹, Dongdong Zhou¹, Fangchao Zheng¹, Tong Liu⁵, Lihua Song¹, Baoxuan Zhang¹, Na Li¹, Huihui Li¹

Affiliations

¹ Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
² State Key Laboratory of Oncogenes and Related Genes, Department of Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China.
⁴ Department of Breast Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
⁵ Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China.

Abstract

Background: Occult breast cancer (OBC) is a rare type of breast cancer, which accounts for 0.3-1.0% of all breast cancers. However, the treatment of OBC remains controversial, especially the local treatment. We aimed to analyze the impact of different treatment and N stage on survival in early-stage OBC patients, and construct a nomogram to predict the prognosis.

Methods: The data of patients with early-stage breast cancer were obtained from 17 registries in the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics and breast cancer-specific survival (BCSS) were compared among the groups. Cox proportional risk models were used for both the univariate and multivariate analyses. Variables with a P value <0.07 in the univariate analysis were included in the multivariate analysis. The independent prognostic factors were included in the nomogram and validated internally.

Results: A total of 492 early-stage OBC patients were randomized at a 7:3 ratio into the training cohort (n=348) and the testing cohort (n=144). N2+ stage patients had a worse prognosis than N1 stage patients (P=0.0051). Triple-negative breast cancer (TNBC) patients had the worst prognosis. Early-stage OBC patients benefited from surgery (P=0.0093) and radiotherapy (P=0.0102), but not chemotherapy (P=0.4030). An analysis of OBC patients with different N stages showed that in terms of treatment, N1 stage patients benefited from surgery (P=0.023), but did not benefit significantly from radiotherapy (P=0.0793), whereas N2+ stage patients benefited from radiotherapy (P=0.0098), but the benefit from surgery was not significant (P=0.1005). In the multivariate analysis, N stage, surgery, and radiotherapy remained statistically significant. Based on the results of the multivariate analysis, we constructed a nomogram for estimating the 3- and 5-year BCSS of OBC patients. The concordance index and the calibration plots show that our nomogram had sufficient accuracy and good coordination.

Conclusions: N stage, surgery, and radiotherapy were identified as independent prognostic factors for OBC. We successfully constructed a nomogram using these independent risk factors and demonstrated that it could help predict the 3- and 5-year BCSS of OBC patients. Further data analyses need to be conducted to revise the treatment of early-stage OBC.

Keywords: Occult breast cancer (OBC); breast cancer specific survival (BCSS); nomogram; risk factor; treatment.