The Effect Of Time To Surgery On The Prognosis Of Breast Cancer And Establishment Of A Prognostic Model For Triple Negative Breast Cancer Based On SEER Database

Background: Time to surgery(TTS)is the focus of attention of both doctors and patients.Research shows that properly prolonging TTS to improve preoperative evaluation is beneficial to breast cancer patients,while too long TTS may threaten the survival of breast cancer patients.The impact of delayed surgery on the prognosis of breast cancer is controversial.This paper mainly studied the effect of short interval group(TTS≤60d)and long interval group(TTS>60d)on the prognosis of breast cancer patients.In addition,we further researched on the relationship between TTS and the prognosis of triple negative breast cancer(TNBC),and built a simple and applicable clinical prediction model for TNBC patients,which can better predict their overall survival(OS).Methods: From the US Surveillance,Epidemiology,and End Results(SEER)Database,we selected 119811 female breast cancer patients who met the inclusion and exclusion criteria from 2010 to 2015.The baseline characteristics of patients in the short interval group and the long interval group were balanced using the propensity score matching(PSM).The risk factors related to OS and BCSS were determined by univariate and multivariate Cox regression analysis.In addition,we selected TNBC patients who meet the inclusion criteria,and used the multivariate Cox prediction model to screen the OS predictors of TNBC patients.Finally,we built the TNBC prognosis prediction model and nomogram including TTS,and evaluated the fitting degree with the C-index,ROC curve and calibration curve.Results:(1)Before PSM,the baseline of demographic characteristics and tumor-related characteristics in the short interval group and the long interval group was unbalanced.Univariate and multivariate Cox analysis of both OS and BCSS showed that TTS was an independent prognostic factor.Patients in the long interval group had poor OS(HR1.40;95% CI 1.26-1.54;P<0.001)and BCSS(HR 1.26;95% CI 1.09-1.43;P=0.002).According to the multivariate Cox proportional model,age,marital status,histological grade,tumor stage,molecular type and TTS are the common independent risk factors for OS and BCSS in breast cancer patients.In addition,systemic therapy is the independent risk factors for OS in breast cancer patients.(2)A total of 11316 TNBC patients with complete information were included and randomly divided into modeling group(7924 cases)and validation group(3392 cases)according to the ratio of 7:3.After multivariate Cox regression analysis,we excluded variables: race,histological classification.A total of 8 variables were selected as independent influencing factors of OS in TNBC patients,including age,marital status,histological grade,tumor stage,TTS,operation,chemotherapy and radiotherapy.The nomogram of TNBC patients’ 3-year and 5-year OS was constructed,the C-index was0.738(95% CI 0.728-0.748,P<0.001).The area under the ROC curve(AUC)of the modeling group for 3 and 5 years was 0.767 and 0.753,respectively.The 3-year and5-year AUC of the validation group were 0.769 and 0.755,respectively.The calibration curves showed that the accuracy of the model is high.Conclusion:(1)The short interval group(TTS≤60d)tends to have better overall survival and breast cancer-specific survival than the long interval group(TTS>60d).Controlling the preoperative waiting time in an appropriate range(TTS≤60d)can fully make preparation for surgery,which is beneficial to the treatment of breast cancer patients.(2)TTS is an independent influencing factor of OS in patients with TNBC.The prediction model and nomogram constructed in this study can predict the risk of OS in patients with TNBC for 3 and 5 years with different preoperative waiting time,with good accuracy,and help doctors provide guidance for the whole treatment of patients with TNBC.