A Competing Risk Analysis Model to Determine the Prognostic Value of Isolated Tumor Cells in Axillary Lymph Nodes for T1N0M0 Breast Cancer Patients Based on the Surveillance, Epidemiology, and End Results Database

Abstract

Introduction: Knowledge of the association between isolated tumor cells (ITCs) in breast cancer patients and the outcome is very limited. We aimed to determine the prognostic value of axillary lymph node ITCs for T1N0M0 female breast cancer (FBC) patients. Methods: Data for T1N0M0 FBC patients staged ITCs negative [pN0(i−)] and positive [pN0(i+)] were extracted from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Prognostic predictors were identified by Kaplan-Meier analysis, competing risk model, and Fine-Gray multivariable regression model. Results: A total of 94,599 subjects were included, 88,632 of whom were staged at pN0(i−) and 5,967 were pN0(i+). Patients staged pN0(i+) had worse breast cancerspecific survival (BCSS) [hazard ratio (HR): 1.298, 95% CI = 1.069-1.576, P = 0.003] and higher breast cancer-specific death (BCSD) rate (Gray's test, P = 0.002) than pN0(i−) group. In the Fine-Gray multivariable regression analysis, the pN0(i+) group had higher BCSD rate (HR: 1.321, 95% CI = 1.109-1.575, P = 0.002) than pN0(i−) group. In subgroup analyses, no significant difference in BCSD was shown between the chemotherapy and non-chemotherapy subgroup (Gray's test, P = 0.069) or radiotherapy and non-radiotherapy subgroup (Gray's test, P = 0.096). Conclusion: ITC was independently related to the increase of the BCSD rate and could be identified as a reliable survival predictor for T1N0M0 FBC patients.

Nomogram for predicting overall survival in patients with invasive micropapillary carcinoma after breast-conserving surgery: A population-based analysis

“…The high tendency of lymphatic vascular invasion, lymph node involvement, as well as a high locoregional recurrence (LRR) risk were supposed to be aggressive clinicopathologic features of IMPC in the previous studies (25-28). Moreover, OS has always seemed as an unbiased measurement for survival prediction of breast cancer (13,14). In the current research, the 5-year OS for conservatively operated IMPC patients was 80.9%, which was slightly lower than 82.9%-90.0% in recent studies (15,16,28,29).…”

“…As reported by previous studies (13)(14)(15)(16), the objective and reliable prognostic indicators, such as AJCC stage, age at diagnosis, and ER status, have always been seemed as the Variable selection by the LASSO binary logistic regression model. A coefficient profile plot was constructed against the log (lambda) sequence.…”

Nomogram for Predicting Overall Survival in Patients With Invasive Micropapillary Carcinoma After Breast-Conserving Surgery: A Population‐Based Analysis

“…As reported by previous studies [11][12][13][14], the objective and reliable prognostic indicators, such as AJCC stage, age at diagnosis, and ER status, have always been seemed as the clinicopathological features which could direct clinical treatment for breast malignancies. In this study, based on the six risk factors affecting OS for IMPC patients undergoing BCS through multivariate Cox regression analyses, the nomogram suggested that AJCC stage contributed most to prognostic prediction, followed by age at diagnosis, ER status and PR status.…”

“…The high tendency of lymphatic vascular invasion, lymph node involvement, as well as a high locoregional recurrence (LRR) risk were supposed to be aggressive clinicopathologic features of IMPC in the previous studies [23][24][25][26]. Moreover, OS has always been seemed as an unbiased measurement for survival prediction of breast cancer [11,12]. In the current research, the 5-year OS for conservatively operated IMPC patients was 80.9%, which was slightly lower than 82.9%-90.0% in recent studies [13,14,26,27].…”

“…In addition, predictive performance of the current nomogram was strictly measured on the aspects of Re ecting on the limitations of this study and the inherent disadvantages of using SEER database [12], some conclusions must be interpreted with caution. Firstly, the design of the study was retrospective and inevitably suffered from possible bias, such as Neyman bias, Berkson bias and lead time bias.…”