Prognostic Factors Analysis And Prognostic Model Establishment Of Young Breast Cancer

Objective: To retrospectively analyze general demographic data,clinicopathological features,and recurrence and survival of early-stage young breast cancer patients who were admitted to the First Affiliated Hospital of China Medical University.Screening out the main clinical pathological factors related to prognosis.Establish a prognosis model based on risk factors to guide treatment.Methods: This study was retrospective.Data were obtained from 1,448 breast cancer patients admitted to the Department of Oncology at the First Affiliated Hospital of China Medical University from 2002-1-1 to 2015-12-31.A total of 316 patients aged 40 years or less accounted for 21.8% of the total.Inclusion criteria:(1)Female breast cancer patients;(2)have received modified radical or breast-conserving surgery;(3)The pathological type is invasive carcinoma;(4)Age ? 40 years old Exclusion criteria:(1)The presence of a second primary tumor in patients with confirmed breast cancer;(2)pathological type is carcinoma in situ or mucinous carcinoma;(3)receiving neoadjuvant or other treatment before surgery;(4)Newly diagnosed patients with stage IV;(5)Patients with DFS <6 months;(6)Patients with incomplete data on clinical data and pathology(including immunohistochemistry);After screening,the study eventually included 242 early-stage breast cancer patients aged 40 years or less.Collect general data and clinical pathological data of patients for analysis.All data were analyzed using SPSS 16.0 statistical software.The chi-square test was used to compare clinical data groups.COX analysis was used for clinical pathology.Kaplan-Meier curve method was used for survival analysis.The survival rate was compared using the Log-rank test.The difference was statistically significant at P<0.05.Based on the independent prognostic factors of DFS and OS in multivariate analysis of cox risk proportional model,a nomogram was drawn to predict the prognosis of young breast cancer.Internal verification using the Bootstrap method(1000 resamples).Concordance index(C-index)was used to evaluate the accuracy of the nomogram prediction model.Finally draw the calibration curve of the nomogram.According to the total score of the nomogram,draw the ROC curve,take the maximum value of the eden index as the demarcation value,divide the overall population into three groups: low-risk,moderate-risk,and high-risk groups.Use the cox proportional hazards model to analyze the adjuvant chemotherapy for low-risk,middle-The impact of the high-risk and high-risk groups,screening for chemotherapy benefiting people,guiding clinical treatment.Results: By the end of the follow-up of 2016-12-31,there were 39 cases of recurrence and metastasis in 242 patients.The 5-year DFS rate was 81.4%.There were 21 deaths due to disease progression.The 5-year OS was 89.4%.Univariate analysis showed that age,mass size,lymph node metastasis,histological grade,and whether postoperative adjuvant chemotherapy reached 4 cycles were associated with DFS.Age,size of the tumor,lymph node metastasis,histological grade,and whether postoperative adjuvant chemotherapy reached 4 cycles had an effect on the patient's OS.Further cox multivariate analysis showed that age,mass size,lymph node metastasis,and histological grade were independent prognostic factors affecting young breast cancer DFS.Age,tumor size,and histological grade were independent prognostic factors affecting OS of young breast cancer.A prognostic risk assessment model was established using independent prognostic factors and validated internally through 1000 Bootstrap self-sampling.The verification result is: the DFS nomogram consistency index is 0.829,and the 95% confidence interval is 0.736-0.894.The nomogram of the OS nomogram is 0.758 with a 95% confidence interval of 0.649-0.876.According to the nomogram model,for the DFS,the total score is <13 divided into low-risk group,13 <total value <24 is the middle-risk group,and the total score> 24 is divided into high-risk group.For the low-risk group,adjuvant chemotherapy with ?4 cycles did not affect DFS(P=0.377),and for moderate-and high-risk patients,adjuvant chemotherapy with ?4 cycles had an effect on patient DFS(medium risk: P=0.040,high risk: P= 0.002);For OS,the total score is less than 8.5 is divided into low-risk group,8.5 <total value is <14 for the middle-risk group,the total score is> 14 is divided into high-risk group.For the low-risk group,?4 cycles of adjuvant chemotherapy did not affect the OS of patients(P=0.704).For patients with medium and high-risk groups,?4 cycles of adjuvant chemotherapy had an effect on patients' OS(medium risk: P=0.048,high risk: P= 0.018);Comprehensive DFS and OS results suggest that adjuvant chemotherapy for ? 4 cycles can improve DFS and OS in patients with moderate to high risk.Conclusions: Age,size of the tumor,histological grade,and lymph node metastasis are independent prognostic factors affecting DFS in young breast cancer.Age,mass size,and histological grade were independent prognostic factors affecting OS of young breast cancer.The DFS and OS nomogram models were established according to the factors of independent prognostic factors in the cox proportional hazards model multivariate analysis.According to the nomogram model,DFS and OS were improved in the medium and high-risk patients with ? 4 cycles of adjuvant chemotherapy.