目的:粘液性乳腺癌(MBC)是乳腺癌的一种,这在临床上是罕见的,主要是女性,因为发病率低,所以没有统一的标准治疗方案。老年患者由于合并合并症而预后不良。本研究旨在探讨手术和放化疗对老年女性MBC患者预后的影响,并构建预测老年女性MBC患者OS和CSS的列线图。
方法:65岁以上女性MBC患者的数据来自监测,流行病学和最终结果(SEER)数据库,患者分为两组:训练集和验证集.预测模型的外部验证数据由昆明市中医医院提供。我们使用Cox回归建模,用于确定影响患者预后的独立危险因素。在根据多因素Cox回归模型避免混杂偏差后,我们使用这些筛选的具有统计学意义的结果来构建柱线图.使用一致性指数(C指数)对模型的性能进行了检验,校正曲线,和接收器的工作特性曲线下的面积(AUC)。随后,我们使用决策曲线分析(DCA)来检验我们列线图的潜在临床价值.
结果:从数据库SEER中提取了8103名老年MBC女性患者,并将其分配到训练和验证集,随机。来自昆明市中医院的83例患者被用于外部验证集。经过多因素Cox回归分析,我们发现年龄,种族,T-stage,M级,手术方法,放射治疗,肿瘤大小是老年MBC患者OS的独立危险因素。同样,CSS的独立危险因素包括年龄,婚姻状况,N级,M阶段,手术方法,化疗,和肿瘤大小。操作系统训练的C索引,验证,外部验证集为0.731(95CI0.715-0.747),0.738(95CI0.724-0.752),和0.809(95CI0.731-0.8874)。训练集的C指数,验证集,CSS的外部验证集为0.786(95CI0.747-0.825),0.776(95CI0.737-0.815),和0.84(95CI0.754-0.926),分别。AUC,校准曲线和DCA也显示出良好的准确性。
结论:在这项研究中,我们构建了一个新的列线图来预测老年MBC患者的预后。列线图经过内部和外部验证,已被证实具有良好的临床适用性。同时,我们发现对于老年女性MBC患者,手术和放疗对他们的生存有很大的好处,但化疗不利于患者生存。
OBJECTIVE: Mucinous breast cancer (MBC) is a kind of breast cancer (BC), which is rare in clinic, mainly for women, because of the low incidence rate, so there is no unified standard treatment protocol. Elderly patients have a poor prognosis due to their combined comorbidities. This study aims to investigate the effect of surgery and chemoradiotherapy on the prognosis of elderly female MBC patients and construct nomograms for predicting the OS and
CSS in elderly female MBC patients.
METHODS: Data for female MBC patients over 65 years are obtained from the Surveillance, Epidemiology and End Results (SEER) database, patients were divided into two groups: the training set and the validation set. External validation data of the prediction model were provided by Kunming Hospital of Traditional Chinese Medicine. We used Cox regression modeling, which was used to identify independent risk factors affecting patient prognosis. After avoiding confounding bias according to the multifactorial Cox regression model, we used these screened statistically significant results to construct column-line plots. The performance of the model was tested using the consistency index (c-index), the calibration curve, and the area under the operating characteristic curve of the receiver (AUC). Subsequently, we used decision curve analysis (DCA) to examine the potential clinical value of our nomograms.
RESULTS: A total of 8103 elderly MBC female patients were extracted from the database SEER and were assigned to the training and validation set, randomly. A total of 83 patients from Kunming Hospital of Traditional Chinese Medicine were used in the external verification set. After multifactorial Cox regression analysis, we found that age, race, T-stage, M-stage, surgical approach, radiotherapy, and tumor size were independent risk factors for OS in elderly MBC patients. Similarly, independent risk factors of
CSS included age, marital status, N stage, M stage, surgical approach, chemotherapy, and tumor size. The C-index for the OS training, validation, and external verification set were 0.731 (95%CI 0.715-0.747), 0.738 (95%CI 0.724-0.752), and 0.809 (95%CI 0.731-0.8874). The C-index of the training set, the validation set, and external verification set for
CSS were 0.786 (95%CI 0.747-0.825), 0.776 (95%CI 0.737-0.815), and 0.84 (95%CI0.754-0.926), respectively. The AUC, calibration curves and DCA also showed good accuracy.
CONCLUSIONS: In this study, we construct a new nomogram to predict the prognosis of elderly patients with MBC. The nomograms have undergone internal and external validation and have been confirmed to have good clinical applicability. At the same time, we found that for elderly female MBC patients, surgery and radiotherapy significantly benefit their survival, but chemotherapy is not conducive to patient survival.