Development and validation of nomograms to predict the survival probability and occurrence of a second primary malignancy of male breast cancer patients: a population-based analysis

Haowei Huang; Zhuoran Li; Zhisheng Huang; Lang Huang; Wei Liu; Guolong Liu; Yuzhen Mo

doi:10.3389/fonc.2023.1076997

Development and validation of nomograms to predict the survival probability and occurrence of a second primary malignancy of male breast cancer patients: a population-based analysis

Front Oncol. 2023 Apr 20:13:1076997. doi: 10.3389/fonc.2023.1076997. eCollection 2023.

Authors

Haowei Huang¹, Zhuoran Li², Zhisheng Huang³, Lang Huang⁴, Wei Liu⁵, Guolong Liu^{6

7}, Yuzhen Mo¹

Affiliations

¹ Department of Radiotherapy, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, China.
² Department of Radiology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, China.
³ Department of Rehabilitation, Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou, Guangdong, China.
⁴ Department of General Office, Guangdong Provincial Hospital of Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, China.
⁵ Department of Breast, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, China.
⁶ Department of Medical Oncology, Guangzhou First People's Hospital, Jinan University, Guangzhou, Guangdong, China.
⁷ Department of Medical Oncology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.

Abstract

Background: Male breast cancer (MBC) is rare, which has restricted prospective research among MBC patients. With effective treatments, the prognosis of MBC patients has improved and developing a second primary malignancy (SPM) has become a life-threatening event for MBC survivors. However, few studies have focused on the prognosis of MBC patients and looked into the SPM issue in MBC survivors.

Method: We reviewed MBC patients diagnosed between 1990 and 2016 from the latest Surveillance, Epidemiology, and End Results (SEER) Plus database. Competing risk models and nomograms were conducted for predicting the risk of cancer-specific death and SPM occurrence. C-indexes, calibration curves, ROC curves, and decision curve analysis (DCA) curves were applied for validation.

Result: A total of 1,843 MBC patients with complete information were finally enrolled and 60 (3.26%) had developed an SPM. Prostate cancer (40%) was the most common SPM. The median OS of all the enrolled patients was 102.41 months, while the median latency from the initial MBC diagnosis to the subsequent diagnosis of SPM was 67.2 months. The patients who suffered from an SPM shared a longer OS than those patients with only one MBC (p = 0.027). The patients were randomly divided into the development cohort and the validation cohort (at a ratio of 7:3). The Fine and Gray competing risk model was used to identify the risk factors. Two nomograms were constructed and validated to predict the 5-year, 8-year, and 10-year survival probability of MBC patients, both of which had good performance in the C-index, ROC curves, calibration plots, and DCA curves, showing the ideal discrimination capability and predictive value clinically. Furthermore, we, for the first time, constructed a nomogram based on the competing risk model to predict the 5-year, 8-year, and 10-year probability of developing an SPM in MBC survivors, which also showed good discrimination, calibration, and clinical effectiveness.

Conclusion: We, for the first time, included treatment information and clinical parameters to construct a nomogram to predict not only the survival probability of MBC patients but also the probability of developing an SPM in MBC survivors, which were helpful in individual risk estimation, patient follow-up, and counseling in MBC patients.

Keywords: male breast cancer; nomogram; prognosis; second primary malignancy; survival probability.

Grants and funding

This study was funded by the Guangzhou Health Science and Technology project (grant numbers 20221A010014 and 20211A011020), the Guangzhou Science and Technology Bureau Program (grant number 202201010806), the research grants of Excellent Science and Technology Talents Project of Guangzhou Red Cross Hospital (WL), and the Research-oriented Hospital Program of Guangzhou (RHPG05). General Health Research Project in Huadu District, Guangzhou (grant number 21-HDWS-066) and Guangzhou Science and Technology Plan Project (grant number 2023A04J0632).