Development and validation of a prognostic nomogram for patients with triple-negative breast cancer with histology of infiltrating duct carcinoma

Na Jing; Ming-Wei Ma; Xian-Shu Gao; Jian-Ting Liu; Xiao-Bin Gu; Min Zhang; Bo Zhao; Yu Wang; Xian-Ling Wang; Hai-Xia Jia

doi:10.21037/atm-20-413

Development and validation of a prognostic nomogram for patients with triple-negative breast cancer with histology of infiltrating duct carcinoma

Ann Transl Med. 2020 Nov;8(21):1447. doi: 10.21037/atm-20-413.

Authors

Na Jing¹, Ming-Wei Ma², Xian-Shu Gao², Jian-Ting Liu¹, Xiao-Bin Gu³, Min Zhang², Bo Zhao^{4

5}, Yu Wang¹, Xian-Ling Wang¹, Hai-Xia Jia¹

Affiliations

¹ Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, China.
² Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
³ Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Engineering Physics, Tsinghua University, Beijing, China.
⁵ Key Laboratory of Particle & Radiation Imaging, Ministry of Education (Tsinghua University), Beijing, China.

Abstract

Background: The purpose of this study was to develop prognostic nomograms from a cohort of patients with triple-negative breast cancer (TNBC) with histology of infiltrating duct carcinoma (IDC) by correlating their clinical and pathological parameters with the rates of disease-free survival (DFS) and overall survival (OS).

Methods: We retrospectively analyzed TNBC patients with histology of IDC at our institution between 2009 and 2012. Age, family history, menopausal status, surgery type, T stage, N stage, histological grade, vascular invasion, perineural invasion, cytokeratin 5/6 status, Ki-67 expression, and epithelial cadherin (E-cadherin) status were analyzed. Predictors were used in multivariable logistic regression analysis to develop a nomogram to predict DFS and OS rates. The nomograms were then subjected to internal validation, with external validation of the nomogram for predicting OS using separate cohorts of TNBC patients known from the Cancer Genome Atlas (TCGA) database. Using the concordance index (C-index) with calibration curves, the predictive accuracy and discriminative ability were calculated.

Results: A total of 242 eligible TNBC patients were included for analysis. The median follow-up time was 70.73 months. Of the patients, 32.6%, 42.6%, and 24.8% had stage I, II, and III disease, respectively. The 3- and 5-year survival rates were 81.0% and 76.5% for DFS, and 86.5% and 81.1%, for OS, respectively. Age, T stage, N stage, and E-cadherin status were found to be risk factors. The nomograms based on those risk factors accurately predicted the 3- and 5-year survival rates. The C-index was 0.798 and 0.821 for DFS and OS, respectively. Besides, the nomogram for OS showed relatively reliable performance in stratifying different risk groups of patients in training and validation cohorts identified from the TCGA database. The C-index reached 0.843. DFS validation was not completed, as there was insufficient data.

Conclusions: Using clinicopathological information, we produced a prognostic nomogram that accurately predicts the 3- and 5-year DFS and OS for patients with TNBC with histology of IDC. More external confirmation is required.

Keywords: Triple-negative breast cancer (TNBC); comprehensive therapy; disease-free survival (DFS); nomogram; overall survival (OS).