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A prognostic scoring model for survival after locoregional therapy in de novo stage IV breast cancer

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Abstract

Background

The role of locoregional treatment (LRT) remains controversial in de novo stage IV breast cancer (BC). We sought to analyze the role of LRT and prognostic factors of overall survival (OS) in de novo stage IV BC patients treated with LRT utilizing the National Cancer Data Base (NCDB). The objective of the current study is to create and internally validate a prognostic scoring model to predict the long-term OS for de novo stage IV BC patients treated with LRT.

Methods

We included de novo stage IV BC patients reported to NCDB between 2004 and 2015. Patients were divided into LRT and no-LRT subsets. We randomized LRT subset to training and validation cohorts. In the training cohort, a seventeen-point prognostic scoring system was developed based on the hazard ratios calculated using Cox-proportional method. We stratified both training and validation cohorts into two “groups” [group 1 (0–7 points) and group 2 (7–17 points)]. Kaplan–Meier method and log-rank test were used to compare OS between the two groups. Our prognostic score was validated internally by comparing the OS between the respective groups in both the training and validation cohorts.

Results

Among 67,978 patients, LRT subset (21,200) had better median OS as compared to that of no-LRT (45 vs. 24 months; p < 0.0001). The group 1 and group 2 in the training cohort showed a significant difference in the 3-year OS (p < 0.0001) (68 vs. 26%). On internal validation, comparable OS was seen between the respective groups in each cohort (p = 0.77).

Conclusions

Our prognostic scoring system will help oncologists to predict the prognosis in de novo stage IV BC patients treated with LRT. Although firm treatment-related conclusions cannot be made due to the retrospective nature of the study, LRT appears to be associated with a better OS in specific subgroups.

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Data availability

The data that support the findings of this study are available from the National Cancer Database (NCDB) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with the permission of NCDB.

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Acknowledgements

The manuscript was submitted to ASCO 2018 and is accepted for poster presentation in American Society of Clinical Oncology proceedings, ASCO 2018, Chicago, IL, USA.

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Author notes

  1. Anuhya Kommalapati and Sri Harsha Tella have contributed equally.

Authors and Affiliations

  1. Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    Anuhya Kommalapati & Sri Harsha Tella

  2. Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA

    Gaurav Goyal

  3. Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-6840, USA

    Apar Kishor Ganti, Jairam Krishnamurthy & Pavan Kumar Tandra

Authors
  1. Anuhya Kommalapati
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  2. Sri Harsha Tella
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  3. Gaurav Goyal
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  4. Apar Kishor Ganti
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  5. Jairam Krishnamurthy
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  6. Pavan Kumar Tandra
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Contributions

Conception and design: AK, SHT, GG, and PKT. Collection and assembly of data: AK and SHT. Data analysis and interpretation: AK, SHT, GG, and PKT. Manuscript writing: AK and SHT. Critical revision of the manuscript: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.

Corresponding author

Correspondence to Pavan Kumar Tandra.

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The authors have no potential conflicts of interest to disclose.

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Kommalapati, A., Tella, S.H., Goyal, G. et al. A prognostic scoring model for survival after locoregional therapy in de novo stage IV breast cancer. Breast Cancer Res Treat 170, 677–685 (2018). https://doi.org/10.1007/s10549-018-4802-2

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  • DOI: https://doi.org/10.1007/s10549-018-4802-2

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