Cancer Res Treat.  2018 Oct;50(4):1140-1148. 10.4143/crt.2017.508.

A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy

• Lim YJ
• Lee SW
• Choi N
• Kwon J
• Eom KY
• Kang E
• Kim EK
• Kim JH
• Kim YJ
• Kim SH
• Park SY
• Kim IA

• KMID: 2424787
• DOI: http://doi.org/10.4143/crt.2017.508

Abstract

PURPOSE
This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer.
MATERIALS AND METHODS
A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model.
RESULTS
The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (≥ 45 years vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029).
CONCLUSION
The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.

Keyword

Breast neoplasms; Adjuvant radiotherapy; Nomogram; Neoplasm metastasis; Prognosis

MeSH Terms

Brain
Breast Neoplasms*
Breast*
Follow-Up Studies
Humans
Mortality
Multivariate Analysis
Neoplasm Metastasis
Nomograms*
Phenobarbital
Prognosis
Proportional Hazards Models
Radiotherapy, Adjuvant*
Recurrence
Phenobarbital

Figure

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  Fig. 1. Survival time according to the initial patterns of failure after postoperative radiotherapy: overall survival (A) and post-progression survival (B).

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  Fig. 2. Baseline hazard function plot of overall survival according to the initial pattern of failure after postoperative radiotherapy.

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  Fig. 3. Nomogram predicting distant metastatic failure. LA, luminal A; LB, luminal B; HER2, human epidermal growth factor receptor 2; TN, triple negative; DMFI, distant metastasis-free interval.

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  Fig. 4. Calibration plot for comparison of predicted and observed 10-year rates of distant metastasis-free interval.

• 

  Fig. 5. Comparison of risk scores according to different metastatic sites (dotted lines: median values).

Reference

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