Survival Estimation, Prognostic Factors Evaluation, and Prognostic Prediction Nomogram Construction of Breast Cancer Patients with Bone Metastasis in the Department of Bone and Soft Tissue Tumor: A Single Center Experience of 8 Years in Tianjin, China

Author:

Xu Yao12,Wu Haixiao12,Xu Guijun23,Yin Zhuming1,Wang Xin24,Chekhonin Vladimir P.25,Peltzer Karl26,Li Shu2,Li Huiyang2,Zhang Jin12,Ma Wenjuan12ORCID,Zhang Chao12ORCID

Affiliation:

1. Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China

2. The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China

3. Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China

4. Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing, China

5. Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia

6. Department of Psychology, University of the Free State, Turfloop, South Africa

Abstract

Purpose. Bone metastasis in breast cancer remains globally concerned. Accurate survival estimation would be beneficial for clinical decision-making, especially for the patients with potential indications of surgery. Based on a retrospective cohort from China, the study aimed to construct a prognostic prediction nomogram for breast cancer patients with bone metastasis. Methods. Breast cancer patients with bone metastasis diagnosed between 2009 and 2017 in our department were retrospectively selected. The total cohort was divided into construction and validation cohorts (ratio 7 : 3). A nomogram was constructed to predict the probability of survival, and the performance of model was validated. Results. A total of 343 patients were enrolled with 243 and 100 patients in construction and validation cohorts, respectively. The median overall survival for the total cohort was 63.2 (95% CI: 52.4–74.0) months. Elevated ALP (HR = 1.71, 95% CI: 1.16–2.51; P = 0.006 ), no surgery for breast cancer (HR = 2.19, 95% CI: 1.30–3.70; P = 0.003 ), synchronous bone metastasis (HR = 1.98, 95% CI: 1.22–3.22; P = 0.006 ), and liver metastasis (HR = 1.68, 95% CI: 1.20–2.37; P = 0.003 ) were independent prognostic factors for worse survival. The independent predictors and other five factors (including age at diagnosis, ER status, PR status, Her-2 status, and the performance of bisphosphonate) were incorporated to construct the nomogram. The C-index was 0.714 (95% CI: 0.636–0.792) and 0.705 (95% CI: 0.705) in the construction cohort and validation cohort, respectively. All the calibration curves were close to the 45-degree line, which indicated satisfactory calibration. Conclusion. A retrospective study aiming at prognostic estimation of breast cancer patients with bone metastasis was designed. Four independent prognostic factors were identified and a prognostic nomogram was constructed with satisfactory discrimination and calibration. The model could be used in survival estimation and individualized treatment planning.

Funder

National Natural Science Foundation of China

Publisher

Hindawi Limited

Subject

Oncology,Surgery,Internal Medicine

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