| Objective This study retrospectively analyzed the 9-year clinical data of a single center,counted the proportion of first-diagnosed stage Ⅳ breast cancer patients(De novo metastatic breast cancer,DnMBC)among patients with advanced breast cancer,analyzed the clinicopathological characteristics and survival status,and explored the Risk factors that affect the prognosis of patients,design a survival prediction model,use the model to quickly calculate the survival probability of DnMBC patients,and provide patients with accurate and personalized treatment options.Methods DnMBC patients from June 2013 to June 2022 were collected as the verification group,SPSS 26.0 software was used for statistical analysis for data analysis,and chi-square test or t-test was used to compare the differences in clinical features between different groups.The survival analysis was performed by kaplan-meier method,the survival curve and forest plot were plotted by Graph pad prism 8.0.0 software,the survival rate difference between different groups was compared by Log-rank test,and the prognostic factors affecting the first diagnosis of stage IV.breast cancer were analyzed by Cox proportional risk regression model,and P < 0.05 was considered to be statistically significant.The first stage IV.breast cancer patients diagnosed by pathology from January 1,2010 to December 31,2015 were extracted by SEER*Stat software as the modeling group,and the clinical factors affecting the prognosis of patients with stage IV.breast cancer who were first diagnosed were explored through multivariate Cox regression analysis,and the model was visualized by R 4.1.3 software,and the nomogram predicted the overall survival rate of 1-year,3-year,and 5-year patients with first-diagnosed stage IV.breast cancer was drawn as a modeling group,and the internal verification was passed Bootstrap method repeated sampling 1 000 self-tests completed;The modeling group verified the model consistency by verifying the calibration curve of the group,and judged whether the specific survival rates of the two groups were consistent through the slope.C-index size measures the reliability of the model,and uses ROC curve and AUC size to reflect the sensitivity and specificity of the model,and finally calculates the risk score of each patient by nomogram,X-tile 3.6.1 software is used to find the best cutoff value to divide patients into different risk groups,and the survival curve is drawn by kaplan-meier method to compare and analyze the population of different risk groups,and P < 0.05 is considered to be statistically significant.Results 1.From June 2013 to June 2022,a total of 356 patients with advanced breast cancer were collected in our hospital,including 104 patients with DnMBC,accounting for 34% of advanced breast cancer;Patients aged 50-60 years had the largest proportion of patients aged50-60 years at the first visit,accounting for 32.1% of the total,followed by patients aged40-50 years with 28.8% of the total.60.6% of the population has not reached menopause,and in terms of geographical distribution,the proportion of breast cancer patients living in rural areas is large,accounting for 63.0% of the total population.2.With the highest proportion of T4 in the T stage,At 41.3%,T1,T2 and T3 accounted for 10.6%,39.4% and 8.7%,respectively;In the N staging period,N3 accounted for the largest proportion,At 37.5%,N1,N2 and Nx accounted for 32.7%,20.2% and 3.8%,respectively;The proportion of patients with a primary pathological type of invasive carcinoma was 97%,Other types including metaplastic carcinoma,micropapillary carcinoma with mucinous carcinoma and other types accounted for 3%;The highest proportion of the molecular typing was type Luminal B,Accounting for 57.7%,The Luminal A type was 10.6%, HER-2 overexpression type was 24.0%,The three-Yin type accounted for 7.7%;High expression of Ki67(20%)accounted for 83.7%,Low expression of Ki67(<20%)was 16.3%;Primary focus was located on the left side of the breast in 56.7%,The proportion of those located on the right side was 43.3%;Histological grades 1-2 accounted for 77.0%,Grade 3and unknown types accounted for 23.0%.3.Bone metastasis accounted for 18.3%,visceral metastasis for 21.2%,soft tissue metastasis for 18.3%,brain metastasis for 1.9%,and 40.3%.Among 104 patients,30(27.9%),including local recurrence 3(2.88%),the common sites of first local recurrence were 2 in the ipsilateral chest wall,1 in the clavicle and 1 in the ipsilateral axillary node;26(25.0%),14(13.5%).4.Patients with surgical treatment group(41 patients)were divided into surgical and non-surgical groups(63 patients).The mean age in the surgical group was 54.08±10.48 years,and in the nonoperative group was 48.49±10.57,with a median follow-up of 32 months.T4 was more common in the non-surgical group compared to the surgical group(86.7%vs.16.3%,P<0.001);in the choice of chemotherapy regimen,the surgical group was more inclined to choose anthracycline-containing drugs(85.7%vs.14.3%,P<0.001),the combination was more preferred in the non-surgical group(71.7%vs.28.3%,P<0.001);the proportion of primary radiotherapy was higher in the surgical group than in the untreated group(73.1%vs.61.9%,P<0.001)。Other clinical and pathological characteristics,including age,menstrual status,N stage,initial site of metastasis,molecular classification,histological grade,KI-67 level,chemotherapy and targeted therapy,showed no significant differences between the two groups(P>0.05)5.With the median survival time of 49 months in the nonsurgical group and of 54 months in the surgical group.There was no statistical difference in the median survival time between the two groups(P>0.05).The median survival time for PFS was 49 months in the nonsurgical group and for PFS was 39 months in the surgical group.There was no statistical difference in the median progression-free survival time between the two groups(P>0.05)6.In univariate analysis showed that the metastasis site,molecular classification,and histological classification were associated with patient OS and PFS(P<0.05);in multivariate analysis,the first metastasis site and molecular classification were independent influencing factors affecting OS in DnMBC patients(P=0.016、P=0.032),and the first metastasis site were independent influencing factors affecting PFS in DnMBC patients(P=0.040).Subgroup analysis found a poor prognosis in patients with multiple metastatic sites and triple-negative breast cancer.7.Further to age,menopausal status,T stage,N stage,metastasis site,histological grade,radiotherapy and chemotherapy,targeted therapy,the results show that the surgical group in the number <3,lower tumor T stage,chemotherapy effective,sequential patients using targeted therapy are more likely to benefit,but the difference has no statistical significance(P>0.05,Table 7).8.Based on the SEER database,a nomogram model with multiple factors was constructed,and the external verification was verified by DnMBC patients in our hospital,the C-indexes of the modeling group and the verification group were 0.690 and 0.878,the AUCs of the modeling group 1,3 years and 5 years were 0.760,0.700 and 0.690,and the AUCs of the 1-year,3-year and 5-year verification groups were 0.910,0.790 and 0.860,respectively The calibration plot curve is also close to 45°,suggesting that the predictive model has a good ability to evaluate the overall survival rate of DnMBC patients at 1 year,3 years and 5 years.With a risk score of 257.5 points,the population in our hospital was divided into two groups,low risk and intermediate risk,and the survival time of the two groups was statistically different(P=0.039).This risk stratification can accurately identify different risk groups for DnMBC patients.Conclusion 1.DnMBC patients accounted for 34.0% of advanced breast cancer in the General Hospital of Ningxia Medical University from June 2013 to June 2022.The age of onset was concentrated in 50-60 years,accounting for 32.1%,followed by patients between40-50 years old,accounting for 28.8% of the total.2.The first metastasis site is an independent factor influencing PFS in DnMBC patients,while molecular classification and first metastasis site are independent influencing factors influencing OS in DnMBC patients,among which patients with multiple site metastasis and triple yin breast cancer often have the worst prognosis.3.The ision of the primary lesion or not,the timing of surgery,the choice of surgical methods and postoperative radiotherapy can not improve the prognosis of patients with DnMBC,and chemotherapy is still the main treatment for patients with DnMBC.4.The DnMBC survival prediction model established in this study under large samples and multiple factors has certain accuracy,and can accurately identify groups at different risks.This may become an effective tool to assess the survival prognosis of DnMBC patients. |
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