Risk Factors, Prognostic Factors, and Nomogram for Distant Metastasis in Breast Cancer Patients Without Lymph Node Metastasis

Abstract

BackgroundLymph node negative (N0) breast cancer can be found coexisting with distant metastasis (DM), which might consequently make clinicians underestimate the risk of relapse and insufficient treatment for this subpopulation.MethodsThe clinicopathological characteristics of N0 breast cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015 were retrospectively reviewed. Multivariate logistic and Cox analyses were used to identify independent risk factors in promoting DM and the 1-, 3-, and 5- year cancer-specific survival (CSS) in this subpopulation.ResultSeven factors including age (<40 years), tumor size (>10 mm), race (Black), location (central), grade (poor differentiation), histology (invasive lobular carcinoma), and subtype (luminal B and Her-2 enriched) were associated with DM, and the area under curve (AUC) was 0.776 (95% CI: 0.763–0.790). Moreover, T1-3N0M1 patients with age >60 years at diagnosis, Black race, triple-negative breast cancer subtype, no surgery performed, and multiple DMs presented a worse 1-, 3-, and 5-year CSS. The areas under the ROC for 1-, 3-, and 5- year CSS in the training cohort were 0.772, 0.741, and 0.762, respectively, and 0.725, 0.695, and 0.699 in the validation cohort.ConclusionThe clinicopathological characteristics associated with the risk of DM and the prognosis of female breast cancer patients without lymph node metastasis but with DM are determined. A novel nomogram for predicting 1-, 3-, 5- year CSS in T1-3N0M1 patients is also well established and validated, which could help clinicians better stratify patients who are at a high-risk level for receiving relatively aggressive management.

New nomogram for predicting lymph node positivity in pancreatic head cancer

“…In this study, tumor size (P=0.023), low levels of albumin (P=0.024), lymphocyte to monocyte ratio (P=0.044) were independent risk factors for LNM, with age (P=0.072) and white blood cells (P=0.055) (WBCs) slightly greater than 0.05, probably due to the small sample size in this experiment. It has also been previously demonstrated that younger age and higher WBC values are strongly correlated with the spread of tumor cells (25)(26)(27)(28)(29)(30) In our study, LNM was found to be significantly correlated with tumor size (p=0.023), which is consistent with the findings of most scholars (31)(32)(33). Previous findings have also focused on the correlation between LMN and tumor size, and although lymph node metastasis was also present in tumors smaller than 1 cm.In general,it appears that larger tumor volumes are more prone to LNM.…”

Fatores Associados ao Karnofsky Performance Status e sua Trajetória no Último Mês de Vida em Pacientes com Câncer Terminal

“…Although most patients had distant metastasis 15,16 , nutritional risk 17 , no association was found between these and functionality, even though they are widely recognized as prognostic factors in cancer. Thus, it is hypothesized that these factors are not associated in the context of the last days of life.…”

The Metastatic Spread of Breast Cancer Accelerates during Sleep: How the Study Design can Affect the Results

“…About one-third of patients with early breast cancer will develop distant metastases (Lobbezoo et al, 2015). Numerous studies have been conducted to explore the determining factors affecting cancer metastasis (Min et al, 2021). Emerging evidence has found the impact of sleep pattern, duration, and quality on cancer metastasis.…”