Risk Stratification Model for Predicting the Overall Survival of Elderly Triple-Negative Breast Cancer Patients: A Population-Based Study

Abstract

Background: The objective of this study was to evaluate the prognostic value of clinical characteristics in elderly patients with triple-negative breast cancer (TNBC).Methods: The cohort was selected from the Surveillance, Epidemiology, and End Results (SEER) program dating from 2010 to 2015. Univariate and multivariate analyses were performed using a Cox proportional risk regression model, and a nomogram was constructed to predict the 1-, 3-, and 5-year prognoses of elderly patients with TNBC. A concordance index (C-index), calibration curve, and decision curve analysis (DCA) were used to verify the nomogram.Results: The results of the study identified a total of 5,677 patients who were randomly divided 6:4 into a training set (n = 3,422) and a validation set (n = 2,255). The multivariate analysis showed that age, race, grade, TN stage, chemotherapy status, radiotherapy status, and tumor size at diagnosis were independent factors affecting the prognosis of elderly patients with TNBC. Together, the 1 -, 3 -, and 5-year nomograms were made up of 8 variables. For the verification of these results, the C-index of the training set and validation set were 0.757 (95% CI 0.743–0.772) and 0.750 (95% CI 0.742–0.768), respectively. The calibration curve also showed that the actual observation of overall survival (OS) was in good agreement with the prediction of the nomograms. Additionally, the DCA showed that the nomogram had good clinical application value. According to the score of each patient, the risk stratification system of elderly patients with TNBC was further established by perfectly dividing these patients into three groups, namely, low risk, medium risk, and high risk, in all queues. In addition, the results showed that radiotherapy could improve prognosis in the low-risk group (P = 0.00056), but had no significant effect in the medium-risk (P < 0.4) and high-risk groups (P < 0.71). An online web app was built based on the proposed nomogram for convenient clinical use.Conclusion: This study was the first to construct a nomogram and risk stratification system for elderly patients with TNBC. The well-established nomogram and the important findings from our study could guide follow-up management strategies for elderly patients with TNBC and help clinicians improve individual treatment.

Determining prognostic factors and optimal surgical intervention for early-onset triple-negative breast cancer

“…Furthermore, the recommended surgical modalities proposed for TNBC remain controversial ( 16 , 18 , 19 , 21 – 23 ). When compared to published data from older counterparts, a higher proportion of young patients with TNBC in our study were African-American, had histologic types other than IDC and ILC, had grade III and undifferentiated diseases, presented with more advanced T and N stage, and had received chemotherapy ( 32 ). Furthermore, both T stage and N stage are strongly associated with prognosis regardless of age ( 32 ).…”

“…When compared to published data from older counterparts, a higher proportion of young patients with TNBC in our study were African-American, had histologic types other than IDC and ILC, had grade III and undifferentiated diseases, presented with more advanced T and N stage, and had received chemotherapy ( 32 ). Furthermore, both T stage and N stage are strongly associated with prognosis regardless of age ( 32 ). However, compared to patients with TNBC overall ( 32 , 33 ), the prognoses of those who were young were not associated with tumor grade, chemotherapy, or radiotherapy according to our multivariable Cox analysis, whereas marital and health insurance statuses were.…”

“…Furthermore, both T stage and N stage are strongly associated with prognosis regardless of age ( 32 ). However, compared to patients with TNBC overall ( 32 , 33 ), the prognoses of those who were young were not associated with tumor grade, chemotherapy, or radiotherapy according to our multivariable Cox analysis, whereas marital and health insurance statuses were. Unmarried women are reportedly more likely to develop advanced-stage breast cancer, as having a spouse may represent a factor supporting the early detection of malignancy ( 34 , 35 ).…”

Nanomaterial-assisted CRISPR gene-engineering – A hallmark for triple-negative breast cancer therapeutics advancement

“…Further, the late hypofractionated accelerated radiotherapy with the dose of 50–52 ​Gy, which was assumed to be relatively safe for breast carcinoma treatment, resulted in 2.2% symptomatic breast oedema, 1.9% asymptomatic fibrosis, 2.2% contralateral breast, 3.7% arm lymphedema, and 1.6% other melanoma in 290 investigated patients during amifostine abridged primary radiotherapy dermatitis [ 213 ]. However, radiation therapy could only recover the prognosis risk in the low-risk TNBC population (P ​= ​0.00056), and revealed non-significant betterment in medium and high-risk patients with short existence duration and mortality within 5 years from diagnosis due to the acquirement of radiotherapy tolerance [ 214 ]. Moreover, radiotherapy impairs healthy cells surrounding by tumour cells, induces a rare tumour named angiosarcoma, heaviness and swelling in the breast, numerical/copy number alteration and structural chromosomal aberrations, and infertility [ 210 ].…”

A novel conditional survival nomogram for monitoring real-time prognosis of non-metastatic triple-negative breast cancer

“…to assist physicians in optimizing clinical decisions and significantly reduce the psychological distress of survivors. However, to our knowledge, although many TNBC prognostic assessment tools have been developed (9,(20)(21)(22)(23)(24)(25)(26)(27), they have never focused on prognostic changes over time. In addition, the common nomograms, while allowing for individualized prediction, have never provided dynamic prognostic information over survival time.…”