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Nomograms for prediction of overall and cancer-specific survival in young breast cancer

  • Epidemiology
  • Published:
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Abstract

Purpose

To assess the prognostic risk factors and establish prognostic nomograms based on lymph node ratio (LNR) to predict the survival of young patients with breast cancer (BC).

Methods

Patients aged < 40 years and diagnosed with BC between 2010 and 2016 from the Surveillance, Epidemiology and End Results database were assessed. Nomograms incorporating LNR were constructed to predict overall survival (OS) and breast cancer-specific survival (BCSS) based on Cox proportional hazards model. The performance of the nomograms was assessed by C-index, calibration curves, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and risk group stratification and compared with the TNM staging system.

Results

Based on the univariate and multivariate Cox regression analysis, significant prognostic factors were identified and integrated to create the nomograms for OS and BCSS. The calibration curves indicated optimal agreement between model predictions and actual observations. The nomograms showed favorable sensitivity with a C-index of 0.8351 (95% CI 0.8234–0.8469) for OS and 0.8474 (95% CI 0.8355–0.8594) for BCSS. The ROC curves of the nomograms showed better predictive ability than those of the TNM staging system for OS (AUC: 0.8503 vs. 0.7819) and BSCC (AUC: 0.8607 vs. 0.8081). Significant differences in Kaplan–Meier curves were observed in patients stratified into different risk groups (p < 0.001).

Conclusions

These nomograms provided more accurate individualized risk prediction of OS and BCSS and may assist clinicians in making decisions for young patients with BC.

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Funding

This study was supported by grants from the National Natural Science Foundation of China (81472731, 81972467), the Guangdong Natural Science Foundation (2020A1515010458), and the Guangdong Science and Technology Department (2017B030314026).

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Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China

    Yi Sun, Jiannan Wu, Huan Tian, Huanhuan Liu, Yingqing Fang, Yudong Li & Fengyan Yu

  2. Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, China

    Yi Sun, Jiannan Wu, Huan Tian, Huanhuan Liu, Yingqing Fang, Yudong Li & Fengyan Yu

  3. Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, 410013, China

    Yuqiang Li

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10549_2020_5870_MOESM1_ESM.tif

ESM_1: Receiver operating characteristic curves comparing the use of the nomograms and AJCC TNM staging system to predict the 3-years OS (A), 5-years overall OS (B), and the 3-years BCSS (C), the 5-years BCSS (D) for young patients with breast cancer in the training group. (OS, overall survival; BCSS, breast cancer-specific survival; AUC, area under the curve) (TIF 16678 kb)

10549_2020_5870_MOESM2_ESM.tif

ESM_2: Decision curve analysis of the nomograms and AJCC TNM staging system for predicting the 3-years OS (A), 5-years overall OS (B), and the 3-years BCSS (C), the 5-years BCSS (D) for young patients with breast cancer in the training group. (OS, overall survival; BCSS, breast cancer-specific survival) (TIF 15724 kb)

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Sun, Y., Li, Y., Wu, J. et al. Nomograms for prediction of overall and cancer-specific survival in young breast cancer. Breast Cancer Res Treat 184, 597–613 (2020). https://doi.org/10.1007/s10549-020-05870-5

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