Prognostic Analysis Of HER2 Positive Metastatic Breast Cancer And Establishment Of Prognostic Model

Purpose: To analyze the clinicopathological characteristics and prognostic factors of HER2 positive metastatic breast cancer.In addition,to identify the independent predictors of HER2 positive metastatic breast cancer with or without anti-HER2 treatment respectively.Methods: There were a total of 1193 patients with advanced breast cancer hospitalized in the Department of Oncology of First Affiliated Hospital of China Medical University from January 2005 to May 2018.356 patients with HER2 positive metastatic breast cancer were involved in this study.The clinicopathological data of these patients were collected and summarized.The data were analyzed by SPSS 25.0 software.Univariate and multivariate analysis were carried out with Cox risk proportional model.Nomogram model was established by using R Project for Statistical Computing 3.5.5 software.1000 Bootstrap self-sampling methods were used for internal verification,and the prediction accuracy was measured by the Harrell's concordance index(C-index).Results: The follow-up ended on January 31,2019.3 patients(0.84%)were lost to follow-up,and 199 patients(55.89%)died.The median overall survival of 390 patients enrolled was 37 months 95%CI32.2-41.8).In univariate analysis,ECOG performance status,hormone receptor status,lymph node metastasis at diagnosis,liver metastasis,non-visceral metastasis,number of metastasis sites,and anti-HER2 treatment were related to OS of HER2 positive metastatic breast cancer.Multivariate analysis showed that,ECOG performance status,lymph node metastasis at diagnosis,liver metastasis,and anti-HER2 treatment were independent prognostic factors of OS.Multivariate analysis in patients without anti-HER2 treatment showed that,ECOG performance status,lymph node metastasis at diagnosis,liver metastasis,and lung metastasis were independent prognostic factors of OS.A nomogram prognostic model was established based on these factors of which the C-index was0.721(95%CI=0.672-0.770).As for patients with anti-HER2 treatment,multivariate analysis showed that,liver metastasis and TTP of anti-HER2 treatment were independent prognostic factors of OS.Conclusions: ECOG performance status,lymph node metastasis,liver metastasis,and anti-HER2 treatment were related to OS of HER2 positive metastatic breast cancer.Liver metastasis and TTP of anti-HER2 treatment were clinicopathological factors affecting prognosis of patients with anti-HER2 treatment.ECOG performance status,lymph node metastasis at diagnosis,liver metastasis,and lung metastasis were independent prognostic factors of OS of patients without anti-HER2 treatment.The nomogram model can be used to predict the prognosis conveniently and visually.