Worse characteristics can predict survival effectively in bilateral primary breast cancer: A competing risk nomogram using the SEER database

Abstract

Objective There is limited information from population‐based cancer registries regarding prognostic features of bilateral primary breast cancer (BPBC). Methods Female patients diagnosed with BPBC between 2004 and 2014 were randomly divided into training (n = 7740) and validation (n = 2579) cohorts from the Surveillance, Epidemiology, and End Results Database. We proposed five various models. Multivariate Cox hazard regression and competing risk analysis were to explore prognosis factors in training cohort. Competing risk nomograms were constructed to combine significant prognostic factors to predict the 3‐year and the 5‐year survival of patients with BPBC. At last, in the validation cohort, the new score performance was evaluated with respect to the area under curve, concordance index, net reclassification index and calibration curve. Results We found out that age, interval time, lymph nodes invasion, tumor size, tumor grade and estrogen receptor status were independent prognostic factors in both multivariate Cox hazard regression analysis and competing risk analysis. Concordance index in the model of the worse characteristics was 0.816 (95% CI: 0.791‐0.840), of the bilateral tumors was 0.819 (95% CI: 0.793‐0.844), of the worse tumor was 0.807 (0.782‐0.832), of the first tumor was 0.744 (0.728‐0.763) and of the second tumor was 0.778 (0.762‐0.794). Net reclassification index of the 3‐year and the 5‐year between them was 2.7% and −1.0%. The calibration curves showed high concordance between the nomogram prediction and actual observation. Conclusion The prognosis of BPBC depended on bilateral tumors. The competing risk nomogram of the model of the worse characteristics may help clinicians predict survival simply and effectively. Metachronous bilateral breast cancer presented poorer survival than synchronous bilateral breast cancer.

Association of molecular subtype concordance and survival outcome in synchronous and metachronous bilateral breast cancer

“…Previous studies have yielded controversial results when comparing the survival outcomes of SBBC and MBBC. Some reported that SBBC was associated with worse prognosis [ 3 , 4 , 33 , 34 , 36 , 37 ], while others stated that SBBC had similar, or even better prognosis compared to MBBC [ 21 , 27 , 35 , 38 ]. The conflicting results could be explained by two main reasons.…”

“…This study also excluded patients who had distant relapse concurrently or before the diagnosis of contralateral breast cancer. Additionally, different from previous studies evaluating the prognostic value of clinicopathological features of unilateral tumor in BBC [ 21 , 27 , 38 ], our study combined the characteristics of bilateral cancers to identify prognostic indicators for SBBC and MBBC. Moreover, the large population-based cohort enables multivariate analyses to identify independent prognostic factors for SBBC and MBBC, while few studies have conducted due to the relatively small sample size of BBC.…”

A nomogram for determining the disease-specific survival in invasive lobular carcinoma of the breast

“…Currently the database includes 18 geographically diverse areas representing 30% of the USA population, with efforts made to accurately reflect the racial, economic, and social diversity of the country. [ 21 – 23 ] In order to obtain reliable research results, we identified 4155 patients with ILC from 2010 to 2015 in the SEER database.…”

A Competing Risk Nomogram for Predicting Cancer-Specific Survival Among Patients with Prostate Cancer after Radical Prostatectomy

“…Competing risk nomogram is a kind of widely used risk predicting model in many elds in oncology such as lung cancer, breast cancer, and colorectal cancer [22][23][24]. The nomogram can incorporate many key factors of the disease into the prognosis prediction model and can consider the weight of each variable to make the prediction model more accurate.…”