Abstract
Purpose
This study aimed to assess the actual prognostic significance of different locoregional treatment (LRT) (surgery and radiotherapy) modalities for stage-IV breast cancer (BC) patients and construct a competing risk nomogram to make precise predictions of the breast cancer-specific death (BCSD) risk among LRT recipients.
Methods
A total of 9279 eligible stage-IV BC patients from the Surveillance Epidemiology and End Results (SEER) database were included in this study. Initially, we evaluated the impact of LRT on survival both before and after the propensity score matching (PSM). Then, we used the Cox hazard proportional model and competing risk model to identify the independent prognostic factors for LRT recipients. Based on the screened variables, a comprehensive nomogram was established.
Results
Kaplan–Meier curves demonstrated that LRT significantly prolonged overall survival (OS) and breast cancer-specific survival (BCSS) (P < 0.001). In addition, patients treated with surgery combined with postoperative radiotherapy (PORT) possessed the optimal survival (P < 0.001). Regardless of the surgical modalities, primary tumor resection combined with radiotherapy could ameliorate the prognosis (P < 0.05). Subgroup analysis showed that in patients with T2-T4 stage, PORT had a survival benefit compared with those undergoing surgery combined with preoperative radiotherapy (PRRT) and surgery only. Based on the screened independent prognostic factors, we established a comprehensive nomogram to forecast BCSD in 1 year, 2 years and 3 years, which showed robust predictive ability.
Conclusion
PORT was associated with a lower BCSD in stage-IV BC patients. The practical nomogram could provide a precise prediction of BCSD for LRT recipients, which was meaningful for patients’ individualized management.
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Data availability
The data presented in this study can be obtained in online repositories: https://seer.cancer.gov.
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Acknowledgements
We acknowledge the data support of the SEER database, as well as the R packages’ developers and providers.
Funding
This study was supported by the Key Research and Development Plan of Shaanxi Provincial Department of Science and Technology (No.2022SF-001) and the International Science and Technology Cooperation Program Project of Shaanxi Province, China (2022KW-01).
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HF K, XB M and ZT X designed the study and supervised the completion, HX C and XT R contributed to data collection and analysis, HX C, XY Z, LY D and DD L wrote the manuscript, YH B and LQ H reviewed the background and edited the manuscript. All the authors approved the final version of the manuscript.
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Cui, H., Ren, X., Zhao, X. et al. Prognostic value and mode selection of locoregional treatment in Stage-IV breast cancer patients. J Cancer Res Clin Oncol 149, 13591–13605 (2023). https://doi.org/10.1007/s00432-023-05159-2
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DOI: https://doi.org/10.1007/s00432-023-05159-2