Development Of A Nomogram For Predicting Menopause In Patients With Hormone Receptor-positive Early Breast Cancer After Adjuvant Therapy

Purpose:Menstrual status is an important reference factor for breast cancer patients to appropriately prescribe endocrine therapy.The aim of this study was to determine the risk factors of menopause after 1 year of endocrine therapy in premenopausal or perimenopausal patients with hormone receptor-positive early breast cancer and to establish a nomogram prediction model.Methods:This is a prospective observational clinical study.An analysis was performed on the clinicopathological and epidemiological data of 233 premenopausal or perimenopausal hormone receptor positive early breast cancer patients aged 45-55 years who met the research requirements from March 2014 to December 2019.SPSS 25.0(IBM Corp,Armonk,NY)statistical analysis software was used to process the clinicopathological and epidemiological data.The measurement data of normal distribution were expressed as mean standard deviation.Counting data was expressed in terms of frequency or percentage.The ratio of each factor to menopause after 1 year of endocrine therapy and its 95%confidence interval were calculated by univariate analysis using epidemiological and clinicopathological features as independent variables.10%were selected as statistically significant cut-off points.And the meaningful factors in univariate analysis were incorporated into multivariate analysis.Stepwise regression was used for multivariate analysis to screen independent risk factors for menopause after 1 year of endocrine therapy.And then the prediction model of nomogram was established,and a bootstrap method(Bootstrap resampling times=1000)was used for internal validation.The ROC was used to evaluate the prediction ability of the model,and further evaluate the prediction accuracy of the model by compiling the confusion matrix.Results:52(22.32%)patients changed from premenopausal or perimenopausal to postmenopausal after 1 year of endocrine therapy.Through the selection of the univariate analysis and the multivariate analysis,chemotherapy cycle which lager than 6 cycles(OR:2.301,95%CI:1.145-4.623,p=0.0192),level of FSH in the begin of endocrine therapy(OR:1.017,95%CI:1.008-1.027,p=0.0167),tamoxifen(OR:0.154,95%CI:0.067-0.356,p=0.0010)(p<0.1)are the risk factors for hormone receptor-positive early breast cancer patients to change from premenopausal or perimenopausal to menopausal after 1 year of endocrine therapy.Based on this,we developed a nomogram model,The prediction accuracy of the nomogram model is 80.26%,and the results of bootstrap method(Bootstrap resampling times=1000)showed that the differentiation and conformity of the prediction model were good.Conclusions:Chemotherapy cycle,endocrine therapy medication regimen,and initial follicle stimulating hormone levels tend to be the risk factors for the transition from premenopausal or perimenopausal status to menopausal status after 1 year of endocrine therapy in breast cancer patients with hormone receptor-positive early breast cancer The prediction model established in this study has good menopause prediction ability and high clinical reference value.This study needs more large samples to be verified and improved.