Analysis Of Prognostic Factors And Establishment Of Prognostic Model Of Patients With HER2-positive Advanced Breast Cancer

Objective: To analyze retrospectively the survival of patients with HER2-positive advanced breast cancer who were treated with trastuzumab in the Department of Medical Oncology of the First Hospital of China Medical University,and to screen out the clinicopathological factors related to prognosis in order to establish an intuitive and convenient prognostic model.Methods: The data of this study were derived from a total of 1728 postoperative breast cancer patients treated in the Department of Oncology,the First Hospital of China Medical University from December 2012 to December 2018.A total of 224 patients with advanced HER2-positive advanced breast cancer who had accepted Trastuzumab treatment were screened for inclusion.The basic information,curative effect and pathological data of the patients were summarized according to the filed medical records and the follow-up table.The database of trastuzumab for HER2-positive advanced breast cancer patients was established and the factors affecting its prognosis were analyzed.All data were statistically analyzed by SPSS R26.0.0.0 software.The R Project for Statistical Computing 3.4.3.was applied to generate the nomogram prognostic model.Univariate and multivariate analyses of overall survival(OS)after relapse were performed using the Cox risk proportional model.The independent prognostic factors derived from multivariate analysis were applied into the nomogram.Kaplan-Meier curves(Log-rank test)were used for survival curves.Bootstrap self-sampling method was applied for1,000 internal validation of the nomogram,and Harrell's concordance index(C-index)was used to measure the prediction accuracy of the model.The difference was statistically significant with P value <0.05.Results: Univariate analysis showed that the number of lymph node metastases,disease-free survival(DFS),whether HR receptor was positive,whether trastuzumab was the first-line drug,the duration of anti-HER2 treatment and hepatic metastasis are related to OS after recurrence in HER2-positive advanced breast cancer patients.Among them,whether HR receptor was positive,whether trastuzumab was the first-line drug,the duration of anti-HER2 treatment and liver metastasis were independent prognosticfactors affecting OS after recurrence of the patients.The nomogram prognostic model of OS established by independent prognostic factors had good discrimination,with C-index of 0.779(95% CI 0.727-0.831,P<0.001).Conclusions: 1.Whether the HR receptor is positive(p = 0.027),whether trastuzumab is a first-line medication(p = 0.001),the duration of anti-HER2 treatment(p=0.028)and liver metastases(p= 0.038)are independent prognostic factors affecting OS after recurrence in patients with HER2-positive advanced breast cancer.2.A nomogram prognostic model established in this study can predict the prognosis of patients with HER2-positive advanced breast cancer treated with trastuzumab.