Authentication of a survival nomogram for non-invasive micropapillary breast cancer

Mingkun Zhang; Yuan Qin; Niuniu Hou; Fuqing Ji; Zhihao Zhang; Juliang Zhang

doi:10.3389/fonc.2023.1156015

Authentication of a survival nomogram for non-invasive micropapillary breast cancer

Front Oncol. 2023 Jul 12:13:1156015. doi: 10.3389/fonc.2023.1156015. eCollection 2023.

Authors

Mingkun Zhang¹, Yuan Qin¹, Niuniu Hou^{1

2}, Fuqing Ji³, Zhihao Zhang³, Juliang Zhang¹

Affiliations

¹ Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shanxi, China.
² Department of General Surgery, Eastern Theater Air Force Hospital of People's Liberation Army (PLA), Nanjing, China.
³ Department of Thyroid Breast Surgery, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, Shanxi, China.

Abstract

Purpose: We aimed at establishing a nomogram to accurately predict the overall survival (OS) of non-metastatic invasive micropapillary breast carcinoma (IMPC).

Methods: In the training cohort, data from 429 patients with non-metastatic IMPC were obtained through the Surveillance, Epidemiology, and End Results (SEER) database. Other 102 patients were enrolled at the Xijing Hospital as validation cohort. Independent risk factors affecting OS were ascertained using univariate and multivariate Cox regression. A nomogram was established to predict OS at 3, 5 and 8 years. The concordance index (C-index), the area under a receiver operating characteristic (ROC) curve and calibration curves were utilized to assess calibration, discrimination and predictive accuracy. Finally, the nomogram was utilized to stratify the risk. The OS between groups was compared through Kaplan-Meier survival curves.

Results: The multivariate analyses revealed that race (p = 0.047), surgery (p = 0.003), positive lymph nodes (p = 0.027), T stage (p = 0.045) and estrogen receptors (p = 0.019) were independent prognostic risk factors. The C-index was 0.766 (95% CI, 0.682-0.850) in the training cohort and 0.694 (95% CI, 0.527-0.861) in the validation cohort. Furthermore, the predicted OS was consistent with actual observation. The AUCs for OS at 3, 5 and 8 years were 0.786 (95% CI: 0.656-0.916), 0.791 (95% CI: 0.669-0.912), and 0.774 (95% CI: 0.688-0.860) in the training cohort, respectively. The area under the curves (AUCs) for OS at 3, 5 and 8 years were 0.653 (95% CI: 0.498-0.808), 0.683 (95% CI: 0.546-0.820), and 0.716 (95% CI: 0.595-0.836) in the validation cohort, respectively. The Kaplan-Meier survival curves revealed a significant different OS between groups in both cohorts (p<0.001).

Conclusion: Our novel prognostic nomogram for non-metastatic IMPC patients achieved a good level of accuracy in both cohorts and could be used to optimize the treatment based on the individual risk factors.

Keywords: SEER; invasive micropapillary breast carcinoma; nomogram; overall survival; prognosis.