Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11338-11348
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11338
Nomogram for predicting overall survival in Chinese triple-negative breast cancer patients after surgery
Wei-Xun Lin, Yan-Na Xie, Yao-Kun Chen, Jie-Hui Cai, Juan Zou, Jie-Hua Zheng, Yi-Yuan Liu, Zhi-Yang Li, Ye-Xi Chen
Wei-Xun Lin, Yao-Kun Chen, Jie-Hui Cai, Juan Zou, Jie-Hua Zheng, Yi-Yuan Liu, Zhi-Yang Li, Ye-Xi Chen, Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
Yan-Na Xie, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
Author contributions: Lin WL, Xie YN, Chen YX, Li ZY, Liu YY, and Cai JH designed the study and conceived the project; Zou J, Zheng JH, Chen YK, and Xie YN performed the experiments and analyzed the data; Lin WX and Xie YN drafted the manuscript; All authors have read and approved the manuscript.
Supported by the Special Fund Project of Guangdong Science and Technology, No. 210728156901524, and No. 210728156901519; Medical Scientific Research Foundation of Guangdong Province, China, No. A2021432, and No. B2021448; Shantou Medical Science and Technology Planning Project, No. 210521236491457, and No. 210625106490696.
Institutional review board statement: Not applicable, Patient data comes from the SEER*stat version 8.3.5.
Informed consent statement: Not applicable, Patient data comes from the SEER*stat version 8.3.5.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ye-Xi Chen, MD, Doctor, Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, No. 69 North Dongxia Road, Shantou 515041, China. yxchen3@stu.edu.cn
Received: September 12, 2021
Peer-review started: September 12, 2021
First decision: January 10, 2022
Revised: January 25, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: November 6, 2022
ARTICLE HIGHLIGHTS
Research background

Triple-negative breast cancer (TNBC) represents 15%–20% of all BCs and has more aggressive biology, earlier onset of metastatic disease, visceral metastases, rapidly progressive disease, inefficacy of endocrine therapy, short response duration to available therapies, and inferior survival outcomes. Nomograms are useful and convenient tools for cancer patients to quantify and predict risk and prognosis. At present, there are few nomograms for Chinese TNBC patients. Thus, the present study aimed to establish and validate a nomogram for TNBC in Chinese patients after surgery. This tool could help improve the management of TNBC in Chinese women.

Research motivation

To explore a nomogram for predicting overall survival in Chinese TNBC patients after surgery.

Research objectives

To construct and validate a nomogram for the overall survival (OS) of Chinese TNBC patients after surgery.

Research methods

This study used the data of SEER*stat 8.3.5 and selected Chinese patients with TNBC operated upon between 2010 and 2015. Univariate and multivariate Cox proportional hazard regression models were used. A predictive nomogram and risk stratification model was constructed by integrating the identified variables; it was assessed with C-indexes and calibration curves.

Research results

The median and maximal OS of the 336 patients was 39 and 83 mo, respectively. The multivariate analysis showed that age (P = 0.043), marital status (P = 0.040), tumor localization (P = 0.030), grade (P = 0.035), T classification (P = 0.012), and N classification (P = 0.002) were independent prognostic factors. The six variables were combined to construct a 1-, 3- and 5-year OS nomogram. The C-indexes of the nomogram to predict OS were 0.766, which was higher than that of the seventh edition tumor, node, metastasis (TNM) staging system (0.766 vs 0.707, P < 0.001). Using the average score of each patient in the nomogram, the risk stratification model was developed to group the patients into two prognostic groups. There was a significant difference between the Kaplan–Meier curves of the entire cohort and each disease stage according to the nomogram. Future studies should aim at validating the results in China.

Research conclusions

A novel nomogram for predicting OS after surgery in Chinese TNBC patients was developed and validated. The included factors are all easy to obtain in the clinical setting, and the prognostic model is convenient to use. This nomogram provides a clear prognostic superiority over the TNM system. It is the first model suitable for risk stratification in long-term survival for Chinese TNBC patients.

Research perspectives

The sample of Chinese patients with TNBC was small in the SEER database. In addition, they were individuals of Chinese descent but living in the USA. Therefore, they do not completely represent the Chinese population living in China. Future studies should aim at validating the results in China.