Development and validation of a risk stratification nomogram for predicting prognosis in bone metastatic breast cancer

Abstract

Bone metastasis seriously affects the survival of breast cancer. Therefore, the study aimed to explore the independent prognostic factors in bone metastatic breast cancer (BMBC) and to construct a prognostic nomogram that can accurately predict the survival of BMBC and strictly divide the patients into different risk stratification. Four thousand three hundred seventy six patients with BMBC from the surveillance, epidemiology, and end results database in 2010 to 2015 were collected and randomly divided into training and validation cohort. Multivariate Cox regression identified the independent prognostic factors of BMBC. A nomogram for predicting cancer-specific survival (CSS) in BMBC was created using R software. The predictive performance of the nomogram was evaluated by plotting receiver operating characteristic (ROC) curves and calibration curves. Marital status, race, age, T stage, tumor grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, brain metastasis, liver metastasis, lung metastasis, chemotherapy, and breast surgery were identified as independent prognostic factors for CSS of BMBC. The area under the ROC curve at 1-, 3-, and 5-year of the nomogram were 0.775, 0.756, and 0.717 in the internal validation and 0.785, 0.737, and 0.735 in the external validation, respectively. Calibration curves further confirmed the unbiased prediction of the model. Kaplan-Meier analysis verified the excellent risk stratification of our model. The first prognostic nomogram for BMBC constructed in our study can accurately predict the survival of BMBC, which may provide a practical tool to help clinicians evaluate prognosis and stratify the prognostic risk for BMBC, thereby determining which patients should be given intensive treatment and optimizing individual treatment strategies for BMBC.

Prediction of bone metastasis risk of early breast cancer based on nomogram of clinicopathological characteristics and hematological parameters

“…Through multivariate analysis, we identified independent risk factors for patients with BMBC. Previous studies have also shown that age, tumor size, tumor grade, and molecular subtype may be risk factors for MBC, which is consistent with the results of our study (21,(23)(24)(25). Our study indicates that pN stage, which reflects the status of the axillary lymph nodes, is an important independent Nomogram to predict the probability of bone metastasis in a patient with non-metastatic breast cancer.…”

The prognosis of breast cancer patients with bone metastasis could be potentially estimated based on blood routine test and biochemical examination at admission

“…Nowadays, in order to predict the outcome and guide the clinical management, more and more researchers prefer to establish clinical prognosis models [ 9 , 10 ]. As a popular quantitative predictive tool, nomogram was usually used to predict the prognosis of cancer patients [ 7 , 11 , 12 ]. Recently, Mao et al.…”

Development and validation of a nomogram for prognosis of bone metastasis in patients with esophageal squamous cell carcinoma：A retrospective study in the SEER database and China cohort

“…Nomogram is a tool that can integrate various factors, such as clinical, pathological, demographic, and oncological factors, to predict medical events and has gained popularity in predicting the prognosis of cancer patients [12,13]. When it comes to intuitively estimating the survival rates of cancer patients, nomograms possess an advantage in terms of accuracy compared to the traditional TNM staging system [14].…”