A nomogram for predicting breast cancer specific survival in elderly patients with breast cancer: a SEER population-based analysis

Abstract

Background The number of elderly patients diagnosed with breast cancer is increasing worldwide. However, treatment decisions for these patients are highly variable. Although researchers have identified the effects of surgery, radiotherapy, endocrine therapy, and chemotherapy in elderly patients with breast cancer, clinicians still struggle to make appropriate decisions for these patients. Methods We identified 75,525 female breast cancer patients aged ≥ 70 years in the Surveillance, Epidemiology, and End Results (SEER) database treated between January 1, 2010, and December 31, 2016. The patients were further divided into training and testing cohorts. The cumulative occurrence of breast cancer-specific deaths (BCSDs) and other cause-specific deaths (OCSD) was calculated using the cumulative incidence function. In the univariate analysis, risk factors were screened using the Fine-Gray model. In the multivariate analysis for competing risks, the sub-distribution hazard ratio with a 95% confidence interval for each independent predictor associated with BCSD was calculated for the construction of nomograms. Based on the above analyses, a competing risk nomogram was constructed to predict the probability of BCSD in the 1st, 3rd, and 5th years after treatment. During validation, the concordance index (C-index) was selected to quantify the predictive ability of the competing risk model. Results A total of 33,118 patients were included in this study, with 24,838 in the training group and 8,280 in the testing group. Age, race, marital status, cancer grade, tumor stage, node stage, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor--2 status, and treatment including surgery, radiation, and chemotherapy were used to establish a nomogram. The C-index of 0.852 (0.842-0.862) in the training cohort and 0.876 (0.868-0.892) in the testing cohort indicated satisfactory discriminative ability of the nomogram. Calibration plots showed favorable consistency between the nomogram predictions and actual observations in both the training and validation cohorts. Conclusions Our study identified independent predictors of BCSD in elderly patients with breast cancer. A prognostic nomogram was developed and validated to aid clinical decision-making.

Adjuvant Chemotherapy for Breast Cancer in Older Adult Patients

“…In a SEER (Surveillance, Epidemiology, and End Results) population-based study, older adults with breast cancer (aged 70 and older) exhibited a negative attitude toward radiotherapy and chemotherapy. 23 A vast majority of the entire population (75,525) underwent surgery, and approximately 50% of the patients received radiation therapy. Only a small portion (15.9%) received chemotherapy.…”

“…Compared with patients who did not undergo radiation or chemotherapy, those who received radiation or chemotherapy had reduced risk of disease-specific death. 23 Thus, for older breast cancer patients without major comorbidity, personalized adjuvant chemotherapy should provide additional survival benefit.…”

Construction and validation of a nomogram for cancer specific survival of postoperative pancreatic cancer based on the SEER and China database

“…Remarkably, the predictive efficiency surpassed that of the AJCC staging system [ 9 ]. Furthermore, the utility of the nomogram has transcended disciplinary boundaries, proving its superior predictive performance over traditional tumor staging methodologies in diverse domains [ 10 – 12 ]. This superiority can be attributed to the nomogram's holistic consideration of a broader spectrum of influential factors.…”

Development of a predictive nomogram for in-hospital death risk in multimorbid patients with hepatocellular carcinoma undergoing Palliative Locoregional Therapy

“…Currently, nomograms are emerging as powerful predictive tools in oncology 10 , 11 , offering personalized risk assessments to enhance clinical decision-making and patient counselling 12 – 14 . In various cancers, nomograms have been successfully employed to provide personalized risk assessments, enhancing clinical decision-making and patient counselling.…”