PDF(Pubmed)
Abstract：
Whether patients with medullary breast carcinoma (MBC) receive chemotherapy is controversial. Therefore, the aim of our study was to screen out patients with MBC who benefit from chemotherapy. We enrolled 618 consecutive patients with MBC from The Surveillance, Epidemiology, and End Results (SEER) database (2010-2018). Cox regression analysis was used to identify independent prognostic factors. Next, a nomogram was constructed and evaluated using calibration plots and the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Kaplan‒Meier curves were used to evaluate the overall survival (OS) benefit of chemotherapy in different risk groups. A total of 618 MBC patients were involved in our study, and an 8:2 ratio was used to randomly split them into a training cohort (n = 545) and a validation cohort (n = 136). Next, a nomogram predicting 3- and 5-year OS rates was constructed based on the five independent factors (age at diagnosis, T stage, N status, subtype and radiation). The nomogram AUCs for 3- and 5-year OS (training set: 0.793 and 0.797; validation set: 0.781 and 0.823) and calibration plots exhibited good discriminative and predictive ability. Additionally, a novel risk classification system for MBC patients demonstrated that we do not have enough evidence to support the benefit effect of chemotherapy for the high-risk group as the result is not statistically significant (total population: p = 0.180; training set: p = 0.340) but could improve OS in the low-risk group (total population: p = 0.001; training set: p = 0.001). Our results suggested that chemotherapy should be selected more carefully for high-risk groups based on a combination of factors and that the possibility of exemption from chemotherapy should be confirmed by more clinical trials in the future.
摘要：
髓样乳腺癌（MBC）患者是否接受化疗存在争议。因此,我们研究的目的是筛选从化疗获益的MBC患者.我们从监测中招募了618名连续的MBC患者，流行病学,和最终结果(SEER)数据库(2010-2018年)。Cox回归分析用于确定独立的预后因素。接下来,使用校准图和受试者工作特征(ROC)曲线的曲线下面积(AUC)构建并评估列线图.使用Kaplan-Meier曲线评估不同风险组化疗的总生存期(OS)获益。共有618例MBC患者参与了我们的研究，使用8:2的比例将它们随机分为训练队列(n=545)和验证队列(n=136).接下来,根据五个独立因素(诊断时的年龄，T级,N状态,亚型和辐射)。3年和5年OS的列线图AUC（训练集：0.793和0.797；验证集：0.781和0.823）和校准图表现出良好的判别和预测能力。此外,针对MBC患者的新型风险分类系统表明,我们没有足够的证据支持化疗对高危组的获益效应,因为结果无统计学意义(总人口:p=0.180;训练集:p=0.340),但可以改善低危组的OS(总人口:p=0.001;训练集:p=0.001).我们的结果表明，应根据多种因素对高危人群更仔细地选择化疗，并且将来应通过更多的临床试验来证实免除化疗的可能性。
