| Objective: To analyze the clinicopathological characteristics of distant metastasis in triple negative breast cancer(TNBC),and to further determine the factors affecting the prognosis of distant metastasis in TNBC,and to establish a prognostic prediction model for clinical treatment decision and prognostic judgment.Methods: The Surveillance,Epidemiology,and End Results(SEER)database of the National Cancer Institute was used to retrieve and extract clinical data of a total of 6709 cases of triple-negative breast cancer diagnosed between January 1,2010 to December 31,2015,which were divided into distant metastasis and non-distant metastasis groups according to whether distant metastasis occurred.The risk factors for distant metastasis in TNBC were explored by using SPSS25.0 software for univariate analysis and multifactor analysis.To further investigate the factors influencing the prognosis of distant metastasis TNBC and to establish a prediction model for the prognosis of distant metastasis TNBC,the clinical data of the distant metastasis group were divided into the modeling group and the internal validation group according to the ratio of 7:3 using R 4.1.3 software.The relevant clinical data of the modeling group were analyzed using COX regression,and significant statistics(p<0.05)were screened according to the results,from which the independent prognostic factors affecting the overall survival time of patients with distant metastasis TNBC were determined,and then the prediction models for the overall survival time of patients with distant metastasis TNBC at 1,3and 5 years were constructed using R software.The receiver operating characteristic curve is used to evaluate the discriminant ability of the prediction model and the calibration curve is used to judge whether the predicted value given by the prediction model is consistent with the actual value,and the internal validation group information was used to internally validate the prediction model;to further test the potential applicability of the prognostic prediction model,the clinical data of patients with TNBC diagnosed as distant metastasis in the Affiliated Hospital of Southwest Medical University from January 1,2017 to December 31,2019 were collected to perform external validation of the prediction model.Results:1.A total of 6709 TNBC patients were included,including 1477 cases in the distant metastasis group and 5232 cases in the non-distant metastasis group.The results of univariate analysis showed that marital status,ethnicity,age,tumor primary location,histological grading,histological type,T stage,and N stage were statistically significant(p<0.05),and tumor laterality(p=0.417)was not statistically significant.The results of multifactorial analysis showed that unmarried,age 66-77 years,age 78-98 years,tumor located in the inner upper quadrant,tumor located in the outer upper quadrant,T2,T3,T4,N1,N2 and N3 were statistically significant(p<0.05)and were independent influencing factors for the development of distant metastasis in TNBC.2.Univariate COX regression showed that marital status,age,tumor primary location,T stage,N stage,whether the primary site was operated,Whether to have chemotherapy,bone metastasis,brain metastasis,lung metastasis and liver metastasis were all statistically significant(p<0.05).Further multifactorial COX regression showed no significance for tumor primary location,and statistical significance(p<0.05)for unmarried,older age,higher T and N stages,primary focus not operated,not treated with chemotherapy,bone metastasis,brain metastasis,lung metastasis and liver metastasis.These 10 variables can be considered as independent risk factors affecting the prognosis of TNBC patients with distant metastasis.The area under the cure(AUC)of the 1-year,3-year and5-year overall survival time in the modeling and internal validation groups were0.782,0.752,0.740 and 0.786,0.759,0.738,respectively,while the calibration curves were all close to the ideal 45° reference line;in addition,the 1-year and3-year overall survival time in the external validation group had AUC values were 0.789 and 0.731 for the external validation group,respectively,and the calibration curves were also basically close to the 45° reference line.Thus,it can be seen that the prediction model has good discriminatory ability in internal and external validation.Conclusion:1.Being unmarried,older than 65 years old,having tumors in the inner upper quadrant,having tumors in the outer upper quadrant,T 2～4,N1～3 are independent risk factors for the development of distant metastases in TNBC.In clinical work,special attention should be paid to these TNBC patients with high-risk metastasis factors to detect metastatic lesions early and take corresponding measures in time to provide opportunities for prolonging patients’ survival time.2.Unmarried,older age,high T and N stage,primary lesion not operated,not treated with chemotherapy,bone metastasis,brain metastasis,lung metastasis and liver metastasis are independent factors for the prognosis of distant metastatic TNBC.3.The prognostic prediction model constructed in this study has good predictive ability to better assess the risk of death in patients with distant metastatic TNBC,and can provide better decisions for individualized treatment in the clinic. |
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