Prognostic Analysis And Nomogram Model Of Newly Diagnosed Stage Ⅳ Breast Cancer Patients Undergoing Local Surgery

Background:The impact of primary site surgery on survival remains controversial in female patients with stage IV breast cancer.The conventional wisdom has been that removal of primary tumor in patients with stage IV breast cancer(BC)is not associated with prolonged survival(except in patients with bone metastasis)and may only be considered for certain patients with systemic disease under control,primarily to improve quality of life Objective:The purpose of this study was to investigate the role of primary tumor surgery in patients with stage IV breast cancer and concurrently develop a nomogram to identify which patients will benefit from surgery.Methods:We retrospectively searched the SEER database for female patients newly diagnosed with stage IV breast cancer(BC)between 2010 and 2015 and then divided them into surgery and non-surgery groups.The propensity score matching(PSM)method was implemented to eliminate the bias,and Kaplan–Meier survival analysis was generated to compare the overall survival(OS)and cancer-specific survival(CSS)between the two groups.After PSM,Cox regression analyses were performed to determine the independent protective value of primary tumor surgery,while logistic regression analyses were utilized to uncover significant predictors of surgical benefit and establish a screening nomogram for female patients with stage IV breast cancer(BC).Nomogram performance was evaluated by calibration curves,receiver operating characteristic(ROC)curves,and C-index were used to evaluate the performance of the lipopograms.Result:4506 patients with stage IV breast cancer(BC)were included in this study,Among them,2644 patients(58.67%)did not receive primary tumor surgery,and1862 patients(41.32%)did.After PSM,the median CSS was 51 months(95%CI:46.27–55.72)in the surgery group compared with only 31 months(95%CI :28.44–33.55)inthe non-surgery group.Wefurther found that primary tumor surgery was an independent protective factor for patients with stage IV breast cancer(BC).Independent factors influencing the benefit of local surgery in patients with stage IV breast cancer(BC)included histological grading(p<0.05),T staging(p<0.05),molecular subtypes(p<0.05),lung metastasis(p<0.05),liver metastasis(p<0.05),brain metastasis(p<0.05)and marital status(p<0.05)chemotherapy(p<0.05),radiotherapy(p<0.05),progesterone status(p<0.05),age(p<0.05).The 3-year and 5-year AUC of the nomogram were 0.756 and0.750 in the training set,and 0.746 and 0.740 in the test set,respectively.The calibration curve and C-index confirmed that the nomogram could precisely predict the possibility of benefit from primary tumor resection.Conclusion:Our study suggested that primary tumor surgery improved the prognosis of female patients with stage IV breast cancer(BC)and developed a nomogram to quantify the probability of surgical benefit to help identify surgical candidates clinically.