A nomogram for survival prediction in 275,812 U.S. patients with breast cancer: a population-based cohort study based on the SEER database

Abstract

Background: Nomograms can assess the risk of clinicopathological features by quantifying the biological and clinical variables of cancer patients. However, the nomogram based on significant factors that influence the survival of breast cancer in a large population has been rarely explored. This study was to investigate the predictive effectiveness of a nomogram for the survival of patients with breast cancer. Methods: Demographic and clinical data of 275,812 breast cancer patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All patients aged ≥20 years in this retrospective cohort study were classified as two groups in a random manner, namely the training set (n=193,069) and validation set (n=82,743). The outcomes of our study were the 3-and 5-year survival of breast cancer. The potential predictors of cancer mortality were screened by univariate and multivariable Cox regression analyses. The nomogram was conducted based on the predictors. Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curve was utilized to evaluate the performance of the nomogram.Results: The age at diagnosis, race, marital status, tumor size, first malignant primary indicator, American Joint Committee on Cancer (AJCC) T stage, M stage, tumor grade, and number of malignant tumors were independent predictors for the death of patients with breast cancer. The C-indexes of the training set and the validation set were 0.782 and 0.778, respectively. The area under the curve (AUC) values of the nomogram for predicting the 3-and 5-year survival of breast cancer were 0.770 and 0.756, respectively. Furthermore, the C-index values of our nomogram were 0.816, 0.775, 0.773, 0.734, and 0.750 for predicting survival in Asian, White, Hispanic, American Indian, and Black populations, respectively. Conclusions:The nomogram may have predictive performance for predicting the 3-and 5-year survival of breast cancer patients, and future studies need to validate our findings.

Prognostic analysis of breast cancer in Xinjiang based on Cox proportional hazards model and two−step cluster method

“…And it was discovered that patients with N1, N2, and N3 subperiods had a higher probability of dying from cancer than patients with N0 subperiods did. The more advanced the N-stage, the more lymph node metastasis and the number of metastases, and then the higher the risk of mortality, which is consistent with previous studies that lymph node metastasis is a frequent clinical characteristic of breast cancer progression ( 19 , 44 ). Given that the HR for M1 in the M-stage was higher than 1 (HR=2.96, 95% CI: 2.04 to 4.29), indicating that distant metastasis is a risk factor for survival.…”

“…Nomograms, in particular, can substitute complicated regression formulas with straightforward, simple-to-understand visual graphs, making it possible to quickly determine the likelihood of a certain outcome event (such as a patient’s death or cancer recurrence) ( 13 , 14 ). Numerous research studies employing nomograms to investigate the prognosis of breast cancer have been conducted ( 15 – 19 ). For instance, Fan et al.…”

Natural history and prognostic model of untreated breast cancer: a study based on the SEER database

“…Age is a signi cant factor affecting the prognosis of breast cancer patients [25,26]. A retrospective study examining the relationship between the age of breast cancer patients and their prognosis found a unique U-shaped association between diagnosis age and breast cancer prognosis [27].…”

A prognostic nomogram for predicting breast cancer survival based on mammography and AJCC staging

“…In Taiwan, specific ethnic and age groups have been found to be disproportionately affected, contributing to over 2000 deaths annually, a number that has been rising in recent years according to local health records [ 1 ]. Several clinical and pathological features, as detailed in the nomogram, have been associated with the long-term prognosis of breast cancer [ 2 , 3 ]. Although the AJCC staging system is widely used, individual patient survival can still vary significantly due to other factors [ 4 ], such as the poor prognosis for young women under 40 and elderly women over 80 with axillary lymph node negative breast cancer [ 2 ] .…”