| Background and Purpose: There is increasing preclinical evidence that steroidal sex hormones,and corresponding estrogen receptors(ER)and progesterone receptors(PR),play an important role in breast cancer bone metastases.However,there are limited data on the prognostic differences in survival of bone metastatic breast cancer with different hormone receptor status,and therefore the prognostic value of ER and PR in breast cancer bone metastasis is unclear,and clarification of these issues is clinically valuable for risk stratification of breast cancer bone metastasis,as well as for determining the intensity of treatment and deciding the appropriate treatment.In this study,we propose to conduct a retrospective cohort study in a large sample to analyze whether there are differences in survival prognosis among different hormone receptor status subgroups based on the ER and PR expression status of primary foci in patients with bone metastases;to further clarify whether hormone receptor status is related to the prognosis of patients with breast cancer bone metastases;and finally to construct a clinical prediction model by including hormone receptor status and other prognosis-related variables to confirm the prognosis of hormone receptor status on breast cancer bone metastases.The prognostic value of hormone receptor status on breast cancer bone metastases was confirmed by incorporating hormone receptor status and other prognostic-related variables.Methods: 554,585 breast cancer patients diagnosed between 2010 and 2018 were screened from Surveillance,Epidemiology,and End Results(SEER)database,among which 19,439 breast cancer bone metastasis cases were screened for the incidence of bone metastasis among different hormone receptor status subgroups to explore The correlation between different hormone receptor status and the occurrence of bone metastasis was explored.To avoid the confounding effect of other organ metastases on survival,10,447 cases with bone metastases only were further screened for subsequent survival prognosis analysis.We further investigated the differences in survival prognosis between the subgroups by Kaplan-Meier survival analysis,and further clarified whether hormone receptor status was a relevant factor in the survival prognosis of breast cancer bone metastases by univariate and multifactorial Cox proportional risk regression analysis.Finally,by integrating the hormone receptor status with other prognostic variables,a survival prediction model for breast cancer bone metastases was constructed to verify the predictive efficacy of the model and prove the prognostic value of hormone receptor status in breast cancer bone metastases.Results: Kaplan-Meier survival analysis showed that the ER+/PR+ subgroup had the best breast cancer-specific survival(BCSS)and overall survival(OS)compared with the other subgroups,and there was no statistically significant difference in survival prognosis between the ER-/PR+ and ER-/PR-subgroups,and survival was worse than the other two groups.Univariate and factorial Cox proportional risk regression analyses showed that hormone receptor status was a prognostic correlate,while clinicopathological variables such as advanced age,male breast cancer,black ethnicity,histological type of invasive lobular carcinoma,high tumor grade,tumor stage T3-T4,HER2-negative,and not receiving surgery with radiotherapy were associated with survival prognosis.Lasso regression was used to further screen prognosis-related variables and construct a clinical prediction model,and the Nomogram was plotted to predict the 3-year and 5-year survival rates of breast cancer bone metastases,and the model showed better calibration and superior predictive efficacy,while clinical decision analysis suggested that the model could achieve a net clinical benefit in predicting the survival rate of breast cancer bone metastases and has some application value.Conclusions: Although ER-positive or PR-positive breast cancer is collectively referred to as hormone-positive breast cancer in previous studies and clinical practice,there are significant survival differences between populations with bone metastases from breast cancer with different receptor status.The results of this study found that different hormone receptor status is a relevant factor in determining the survival prognosis of breast cancer bone metastases,and a clinical prediction model that integrates the variable of hormone receptor status has better survival prediction efficacy.Therefore,hormone receptor status needs to be considered when selecting the intensity of treatment regimen for patients with bone metastases from breast cancer with different ER and PR status. |
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