Individualized Prediction of Survival Benefit From Locoregional Surgical Treatment for Patients With Metastatic Breast Cancer

Abstract

Objective: Recently, performing locoregional surgical treatment still remains debatable in patients with metastatic breast cancer (MBC). Current study aimed to develop prognostic nomograms for predicting the long-term survival in MBC patients with or without surgical intervention, thereby assisting clinicians in making individualized choice.Methods: The training set included 5173 patients who were diagnosed with MBC in 2010-2013 from the Surveillance, Epidemiology, and End Results Program, while the validation set comprised 2924 patients diagnosed in 2014-2015. Multivariant Cox hazard model was applied to determine the independent risk factors for overall survival (OS) and breast cancer specific survival (BCSS). Then, individualized pre-and postoperative nomograms for predicting 1-or 3-year survival probabilities were constructed accordingly. Internal and external validations were conducted to determine the accuracy of these nomograms by calculating concordance index (C-index) and plotting calibration curves.Results: The survival analysis indicated that surgical management conferred improved OS and BCSS in patients with metastatic breast cancer. Age, T stage, grade, distant metastatic site, ER, PR and HER2 status, radiation, and chemotherapy were independent risk factors for OS and BCSS both in surgery and non-surgery group. All these factors were subsequently incorporated into the nomogram which showed acceptable predictive capabilities with C-index range of 0.65-0.80 both in training set and external validation set. In addition, a preoperative nomogram incorporating variables capable of being determined before surgery was also built with C-index above 0.70 both in training and validation set. Conclusion:Surgical management in patients with metastatic breast cancer suggests a potential survival advantage. In addition, these well-validated pre-and postoperative nomograms may provide a useful tool to assist clinicians in treatment decision-making and in evaluating patients' long term prognosis.

Surgery for Primary Tumor Benefits Survival for Breast Cancer Patients With Bone Metastases: A Large Cohort Retrospective Study

“…To date, the role of primary tumor surgery in the treatment of breast cancer patients with BM remains unclear and there is no consensus. The prognostic role of surgery in patients with stage IV or distant metastases of breast cancer has been reported in many previous studies [19,20]. A retrospective study by Jennifer et al compared the OS rates of women who underwent surgery with those who did not, and the multivariate analysis showed that patients with stage IV breast cancer who underwent surgery had a signi cantly longer median survival than those who did not (P<0.001) [21].…”

Establishing a predicted model to evaluate prognosis for initially diagnosed metastatic Her2-positive breast cancer patients and exploring the benefit from local surgery

“…Recently, Pons-Tostivint et al [ 29 ] conducted a large-scale multicentric retrospective study of 4276 de novo MBC patients, which concluded that locoregional surgery of the primary tumor would improve OS, except for patients with triple-negative molecular subtype. In addition, Zheng et al [ 30 ] draw a conclusion that surgical management of MBC patients carried out a potential survival advantage via reviewing 5173 patients from the SEER database, but the surgical benefit for different subtypes and populations remained unclear. Xiao [ 31 ] et al performed a large-scale meta-analysis consisting of three randomized clinical trials of 714 participants and 30 observational studies of 67,272 participants, and found that resection of primary lesion contributed to better OS (OS (HR 0.65, 95%CI, 0.61–0.70) and distant progression-free survival (HR 0.42, 95%CI, 0.29–0.60), but didn’t contribute to disease-free survival.…”

“…Recently, Pons-Tostivint et al [29] conducted a large-scale multicentric retrospective study of 4276 de novo MBC patients, which concluded that locoregional surgery of the primary tumor would improve OS, except for patients with triple-negative molecular subtype. In addition, Zheng et al [30] draw a conclusion that surgical management of MBC patients carried out a potential survival advantage via reviewing 5173 patients from the SEER database, but the surgical benefit for…”

A System Pharmacology Model for Decoding the Synergistic Mechanisms of Compound Kushen Injection in Treating Breast Cancer

“…Breast cancer (BC) is the most common cancer in women worldwide and is responsible for the second highest death rate among female patients with cancer ( Siegel et al, 2020 ). Many options are available to treat breast cancer, such as surgical treatment ( Zheng et al, 2020 ), radiation therapy ( Balaji et al, 2016 ), neoadjuvant endocrine therapy ( Yao et al, 2019 ), neoadjuvant chemotherapy ( Vaidya et al, 2018 ), and anti-HER2 therapy ( Yao and Fu, 2018 ). However, side effects of these treatments are often observed.…”