Breast Subtypes and Prognosis of Breast Cancer Patients With Initial Bone Metastasis: A Population-Based Study

Abstract

BackgroundMetastatic breast cancer (MBC) is a highly heterogeneous disease and bone is one of the most common metastatic sites. This retrospective study was conducted to investigate the clinical features, prognostic factors and benefits of surgery of breast cancer patients with initial bone metastases.MethodsFrom 2010 to 2015, 6,860 breast cancer patients diagnosed with initial bone metastasis were analyzed from Surveillance, Epidemiology, and End Results (SEER) database. Univariate and Multivariable analysis were used to identify prognostic factors. A nomogram was performed based on the factors selected from cox regression result. Survival curves were plotted according to different subtypes, metastatic burdens and risk groups differentiated by nomogram.ResultsHormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) positive patients showed the best outcome compared to other subtypes. Patients of younger age (<60 years old), white race, lower grade, lower T stage (<=T2), not combining visceral metastasis tended to have better outcome. About 37% (2,249) patients received surgery of primary tumor. Patients of all subtypes could benefit from surgery. Patients of bone-only metastases (BOM), bone and liver metastases, bone and lung metastases also showed superior survival time if surgery was performed. However, patients of bone and brain metastasis could not benefit from surgery (p = 0.05). The C-index of nomogram was 0.66. Cutoff values of nomogram point were identified as 87 and 157 points, which divided all patients into low-, intermediate- and high-risk groups. Patients of all groups showed better overall survival when receiving surgery.ConclusionOur study has provided population-based prognostic analysis in patients with initial bone metastatic breast cancer and constructed a predicting nomogram with good accuracy. The finding of potential benefit of surgery to overall survival will cast some lights on the treatment tactics of this group of patients.

Osteosarcoma and Metastasis Associated Bone Degradation—A Tale of Osteoclast and Malignant Cell Cooperativity

“…These numbers are supported by other reports covering the same period for Danish and international cohorts [8][9][10][11][12][13]. Survival rates are likely to have improved since then [14][15][16], but bone metastasis remains an incurable condition. Contributing to the poor prognosis are the consequences of bone metastases such as anemia, increased susceptibility to infection, life-threatening hypercalcemia, spinal cord compression, severe pain, fatigue, increased risk of skeletal fractures, and decreased mobility [17][18][19][20].…”

A Nomogram-based Model to Predict Neoplastic Risk for Patients with Gallbladder Polyps

“…Nomogram modelling has been used effectively in a number of studies. 29,30 We recommend that patients who are judged to be at high risk using our diagnostic model should have supplemental CT scans before surgery to confirm the diagnosis and rule-out abdominal metastasis of GBC. Additionally, compared with artificially assigning risk factors, assigning corresponding weights to variables through statistical methods may result in more objective extraction of information from clinical data.…”

A Nomogram-Based Model to Predict Neoplastic Risk For Patients With Gallbladder Polyps

“…All the indicators included in our model can be obtained through physical examination of outpatient. Modelling by using nomograms has been used in a number of studies and has been shown to be effective [29] [30]. We recommend that patients who are judged to be at high risk through our diagnostic model could be supplemented with CT scans before surgery to further con rm the diagnosis and rule out gallbladder cancer abdominal metastasis.…”