A Novel Prognostic Nomogram for Predicting Survival of Hormone Receptor-Positive and HER2 Negative Advanced Breast Cancer Among the Han-Population

Abstract

PurposeTo develop a nomogram model to predict overall survival in HR+/HER2- subtype advanced breast cancer.MethodsA total of 3,577 ABC (advanced breast cancer) patients from 21 hospitals in China were involved in this study from January 2012 to December 2014. From all ABC patients, 1,671 HR+/HER2- ABC patients were extracted and enrolled in our study. A nomogram was built based on univariable and multivariable Cox regression analyses, identifying independent predictors. The discriminatory and predictive capacities of the nomogram were assessed using the ROC (receiver operating characteristic) curve and calibration plots.ResultsUnivariable and multivariable analysis found that ER (estrogen receptor) status, MFIs (metastatic-free intervals), first-line therapy options, the number of metastatic sites, and whether local therapy for metastatic sites was chosen, were significantly related to overall survival (all P < 0.05). These variables were incorporated into a nomogram to predict the 2- year, 3-year, and 5-year OS (overall survival) of ABC patients. The AUC (the area under the curve) of the nomogram was 0.748 (95% CI (confidence interval):0.693-0.804) for 5-year OS in the training cohort and 0.732 (95% CI: 0.676-0.789) for the validation cohort. The calibration curves revealed good consistency between actual survival and nomogram prediction in the training and validation cohorts. Additionally, the nomogram showed an excellent ability to stratify patients into different risk cohorts.ConclusionWe established a nomogram that provided a more straightforward predictive model for the outcome of HR+/HER2- ABC subtype patients and, to some extent, assisted physicians in making the personalized therapeutic option.

Development and Validation of a Prognostic Nomogram for HR+ HER- Breast Cancer

“…In addition, our nomograms showed significantly higher C-index and larger AUCs than that of the eighth AJCC TNM staging system in predicting DFS. There are few nomograms predicting the prognosis of HR+ HER2-breast cancers and biomarkers associated with the inflammatory response are not included these nomograms [13][14][15] and many nomograms focused on OS or BCSS but not DFS. Our study made up for these shortcomings.…”

“…12 There are few nomograms predicting the prognosis of HR+ HER2-breast cancer and biomarkers associated with inflammatory response are not included in these nomograms. [13][14][15] Only one nomogram was developed to screen out low-risk HR+ HER2-breast cancer patients who were exempt from adjuvant chemotherapy. 14 Based on the Surveillance, Epidemiology, and End Results (SEER) database that contains a small number of Asians, the applicability of this nomogram for Chinese population remains to be considered.…”

Relationship between telomere length and the prognosis of breast cancer based on estrogen receptor status: A Mendelian randomization study

“…About 70% of breast cancer cases could be detected in the expression of ER (6). Its biological characteristics and prognosis are distinctly different from other subtypes, which show sensitivity to anti-hormone therapy (7). Compared to patients with estrogen receptor-negative (ER-, ER<1% is considered ER-) breast cancer, patients with estrogen receptor-positive (ER+, ER>=1% is considered ER+) breast cancer had a better prognosis (8).…”