背景被诊断为新发转移性乳腺癌(dnMBC)的患者的寿命已经延长。尽管如此,关于这一特殊亚组患者的即时乳房再造(IBR)仍存在大量争论.这项研究的目的是构建一个列线图,预测接受IBR的dnMBC患者的乳腺癌特异性生存率(BCSS)。方法对2010年至2018年初次诊断为转移性乳腺癌(MBC)的682例患者进行监测,流行病学,和最终结果(SEER)数据库纳入本研究。所有患者以7:3的比例随机分为训练和验证组。单变量Cox风险回归,最小绝对收缩和选择运算符(LASSO),最佳子集回归(BSR)用于初始变量选择,然后进行后向逐步多变量Cox回归,以确定预后因素并构建列线图。在用一致性指数(C指数)验证列线图后,接收机工作特性(ROC)曲线,校正曲线,和决策曲线分析(DCA),建立了风险分层。结果年龄,婚姻状况,T级,N级,乳腺亚型,骨转移,脑转移瘤,肝转移,肺转移,放射治疗,化疗是BCSS的独立预后因素。C指数为0.707[95%置信区间(CI),0.666-0.748]在训练组和0.702(95%CI,0.639-0.765)在验证组。在训练组中,BCSS的AUC为0.857(95%CI,0.770-0.943),0.747(95%CI,0.689-0.804),和0.700(95%CI,0.643-0.757)在1年,3年,5年,分别,在验证组中,AUC为0.840(95%CI,0.733-0.947),0.763(95%CI,0.677-0.849),和0.709(95%CI,0.623-0.795)。BCSS概率预测的校准曲线表现出优异的一致性。DCA曲线表现出强大的鉴别力,并产生了可观的净收益。结论列线图,基于预后风险因素构建,有能力为接受IBR的dnMBC患者的BCSS提供个性化预测,并为临床决策提供有价值的参考。
Background The lifespan of patients diagnosed with de novo metastatic breast cancer (dnMBC) has been prolonged. Nonetheless, there remains substantial debate regarding immediate breast reconstruction (IBR) for this particular subgroup of patients. The aim of this study was to construct a nomogram predicting the breast cancer-specific survival (BCSS) of dnMBC patients who underwent IBR. Methods A total of 682 patients initially diagnosed with metastatic breast cancer (MBC) between 2010 and 2018 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. All patients were randomly allocated into training and validation groups at a ratio of 7:3. Univariate Cox hazard regression, least absolute shrinkage and selection operator (LASSO), and best subset regression (BSR) were used for initial variable selection, followed by a backward stepwise multivariate Cox regression to identify prognostic factors and construct a nomogram. Following the validation of the nomogram with concordance indexes (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analyses (DCAs), risk stratifications were established. Results Age, marital status, T stage, N stage, breast subtype, bone metastasis, brain metastasis, liver metastasis, lung metastasis, radiotherapy, and chemotherapy were independent prognostic factors for BCSS. The C-indexes were 0.707 [95% confidence interval (CI), 0.666-0.748] in the training group and 0.702 (95% CI, 0.639-0.765) in the validation group. In the training group, the AUCs for BCSS were 0.857 (95% CI, 0.770-0.943), 0.747 (95% CI, 0.689-0.804), and 0.700 (95% CI, 0.643-0.757) at 1 year, 3 years, and 5 years, respectively, while in the validation group, the AUCs were 0.840 (95% CI, 0.733-0.947), 0.763 (95% CI, 0.677-0.849), and 0.709 (95% CI, 0.623-0.795) for the same time points. The calibration curves for BCSS probability prediction demonstrated excellent consistency. The DCA curves exhibited strong discrimination power and yielded substantial net benefits. Conclusions The nomogram, constructed based on prognostic risk factors, has the ability to provide personalized predictions for BCSS in dnMBC patients undergoing IBR and serve as a valuable reference for clinical decision making.