Cancer Res Treat.  2018 Oct;50(4):1260-1269. 10.4143/crt.2017.443.

Score for the Survival Probability in Metastasis Breast Cancer: A Nomogram-Based Risk Assessment Model

• Xiong Z
• Deng G
• Huang X
• Li X
• Xie X
• Wang J
• Shuang Z
• Wang X

• KMID: 2424798
• DOI: http://doi.org/10.4143/crt.2017.443

Abstract

PURPOSE
Survival of metastatic breast cancer (MBC) patient remains unknown and varies greatly from person to person. Thus, we aimed to construct a nomogram to quantify the survival probability of patients with MBC.
MATERIALS AND METHODS
We had included 793 MBC patients and calculated trends of case fatality rate by Kaplan-Meier method and joinpoint regression. Six hundred thirty-four patients with MBC between January 2004 and July 2011 and 159 patients with MBC between August 2011 and July 2013 were assigned to training cohort and internal validation cohort, respectively. We constructed the nomogram based on the results of univariable and multivariable Cox regression analyses in the training cohort and validated the nomogram in the validation cohort. Concordance index and calibration curves were used to assess the effectiveness of nomogram.
RESULTS
Case fatality rate of MBC was increasing (annual percentage change [APC], 21.6; 95% confidence interval [CI], 1.0 to 46.3; p < 0.05) in the first 18 months and then decreased (APC, -4.5; 95% CI, -8.2 to -0.7; p < 0.05). Metastasis-free interval, age, metastasis location, and hormone receptor status were independent prognostic factors and were included in the nomogram, which had a concordance index of 0.69 in the training cohort and 0.67 in the validation cohort. Calibration curves indicated good consistency between the two cohorts at 1 and 3 years.
CONCLUSION
In conclusion, the fatality risk of MBC was increasing and reached the summit between 13th and 18th month after the detection of MBC. We have developed and validated a nomogram to predict the 1- and 3-year survival probability in MBC.

Keyword

Breast neoplasms; Metastasis; Mortality rate; Survival; Nomogram

MeSH Terms

Breast Neoplasms*
Breast*
Calibration
Cohort Studies
Humans
Methods
Mortality
Neoplasm Metastasis*
Nomograms
Risk Assessment*

Figure

• 

  Fig. 1. Mortality risk of metastatic breast cancer (MBC) patients. (A) Kaplan-Meier survival curves estimate case fatality rate of MBC patients: the 1-, 3-, and 5-year fatality rate were 14.5%, 46.5%, and 60.8%, respectively. (B) Analysis of trend of fatality rate per month by Joinpoint regression: the joinpoint of lines was located at 13-18 (95% confidence interval [CI], [13-18] to [25-30]); trend 1 of fatality rate ranged from 0 to 18th month (annual percentage change [APC], 21.6; 95% CI, 1.0 to 46.3; p < 0.05); trend 2 of fatality rate ranges from 19th to 60th month (APC, –4.5; 95% CI, –8.2 to –0.7; p < 0.05).

• 

  Fig. 2. Prognostic nomogram for metastatic breast cancer patients with factors, including age, metastasis-free interval (MFI), location of metastasis site, and hormone receptor (HR) status. Points are defined based on the prognostic contribution of the factors (top). Points summing the contribution of age, MFI, location of metastasis site, and HR status are translated to the survival probability at 1 and 3 years (bottom). CNS, central nervous system.

• 

  Fig. 3. Calibration plots for predicting patient survival at 1 and 3 years in the training and validation cohorts. Calibration plots of survival probability in training (A) and validation (B) cohort. Probability of survival based on the nomogram has been listed on the x-axis, while actual probability of survival has been listed on the y-axis. OS, overall survival.

Reference

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