Establishment and Verification of Prognostic Nomograms for Young Women With Breast Cancer Bone Metastasis

Zhan Wang; Haiyu Shao; Qiang Xu; Yongguang Wang; Yaojing Ma; Diarra Mohamed Diaty; Jiahao Zhang; Zhaoming Ye

doi:10.3389/fmed.2022.840024

Establishment and Verification of Prognostic Nomograms for Young Women With Breast Cancer Bone Metastasis

Front Med (Lausanne). 2022 Apr 12:9:840024. doi: 10.3389/fmed.2022.840024. eCollection 2022.

Authors

Zhan Wang^{1

2

3}, Haiyu Shao^{1

2

3

4}, Qiang Xu⁵, Yongguang Wang¹, Yaojing Ma^{1

2

3}, Diarra Mohamed Diaty^{1

2

3}, Jiahao Zhang^{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.
⁴ Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
⁵ Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, China.

Abstract

Purpose: The prognosis of patients with metastatic breast cancer usually varies greatly among individuals. At present, the application of nomogram is very popular in metastatic tumors. The present study was conducted to identify independent survival predictors and construct nomograms among young women with breast cancer bone metastasis (BCBM).

Patients and methods: We searched the Surveillance, Epidemiology, and End Results (SEER) database to identify young women diagnosed with BCBM between 2010 and 2016. We first analyzed the potential risk factors of overall survival (OS) and cancer-specific survival (CSS) by applying univariate Cox regression analysis. Then we conducted multivariate Cox analysis to identify independent survival predictors. Based on significant independent predictors, we developed and validated novel prognostic nomograms by using the R version 4.1.0 software.

Results: We finally identified 715 eligible young women with BCBM for survival analysis, of which 358 patients were in the training set, and 357 patients in the validation set. Approximately four-fifths of patients are between 31 and 40 years old. The 5-year OS and CSS rates of this research population were 41.9 and 43.3%, respectively. Multivariate analysis revealed seven independent predictors of both OS and CSS, including race, tumor subtype, tumor size, surgical treatment, brain metastasis, liver metastasis, and lung metastasis. Based on these predictors, we developed and validated OS and CSS nomograms. The C-index of the OS nomogram reached 0.728 and 0.73 in the training and validation sets, respectively. The C-index of the CSS nomogram reached 0.743 and 0.695 in the training and validation sets, respectively. Meanwhile, high quality calibration plots were revealed in both OS and CSS nomograms.

Conclusion: The current novel nomograms can provide an individualized survival evaluation of young women with BCBM and instruct clinicians to treat them appropriately.

Keywords: bone metastasis; breast cancer; nomogram; predictor; survival; young women.