Prognostic Factors Analysis And Prediction Model Establishment Of Breast Squamous Cell Carcinoma Based On SEER Database

Objective: The purpose of this study was to investigate the factors that influence the overall survival(OS)of patients with Primary squamous cell carcinoma of the breast(PSCCB)using the SEER database.A Nomogram survival prediction model was established based on influencing factors and validated,and the effects of breastconserving surgery and total mastectomy on breast cancer-specific survival(BCSS)were analyzed.To guide clinicians in the individual evaluation and treatment of PSCCB patientsMethods: The full name of the SEER database is "The Surveillance,Epidemiology,and End Results".It was established by the National Cancer Institute in 1973 and covers approximately one-third of the population of the United States.Download the data of a total of 191 cases of PSCCB patients diagnosed pathologically from 2000 to 2015 through the SEER database software.The variables were subjected to univariate Cox regression analysis,and then the univariate regression analysis was statistically significant(P<0.05))Variables are included in the multivariate Cox regression analysis to obtain statistically significant independent prognostic factors,establish a Nomogram survival prediction model,and use the C index(concordance index,)for discrimination evaluation and Calibration curves are used to test the fit of the nomogram.According to the nomogram,patients were divided into low-risk group,medium-risk group,and high-risk group according to their personal total scores,and the impact of survival curves of different risk groups on the overall survival of patients was evaluated.Groups were grouped by surgical methods(breast-conserving surgery and total breast resection),and propensity score matching was used to eliminate the potential interference of different clinical data of patients in different surgical groups to study whether PSCCB breast cancer-specific survival(BCSS)could benefit from no surgery.It is considered that P<0.05 is considered to be statistically significant.Results: 1.In univariate Cox regression analysis results,age,marital status,tumor T stage,tumor N stage,tumor M stage,chemotherapy status,radiotherapy status and surgical treatment were correlated with overall survival(OS)(all P < 0.05).2.According to the results of Cox multivariate analysis,marital status,tumor T stage(any T with metastasis = M1 stage in tumor M stage),N stage,and surgical methods are constructed to influence the prognosis of patients with primary squamous cell carcinoma of the breast(PSCCB)Independent influencing factors of the nomogram.3.The degree of discrimination of the nomogram prediction model is tested by the concordance index(C-index),C-index=0.828(95%CI: 0.790-0.866)shows that the degree of discrimination is good,and the calibration curve is close to the 45° diagonal Overlap,showing a good degree of fit.It shows that the nomogram has good predictive performance and matches the actual situation.4.Perform risk stratification according to the nomogram scores of patients,and divide them into three groups: low-risk group,medium-risk group and high-risk group.Kaplan-Meier survival analysis is performed and survival curve is drawn.The difference of overall survival(OS)among all groups was verified by Log Rank,which proved the accuracy of risk stratification based on the prediction model.5.Divided 166 patients into breast-conserving surgery group and total breast resection group according to the surgical method,and conducted Gray test through the competitive risk model and plotted the cumulative incidence curve of tumor BCSS.The results showed that breast-conserving surgery is compared with breast total resection.Surgery is a protective factor for patients with tumor-specific death(BCSS)(P<0.05).In order to eliminate the potential differences in the case data of the two groups of patients(tumor T staging,radiotherapy status),the propensity score matching method(PSM)was used for 1:1 matching.After obtaining the data of the two groups of patients 45 cases,the Gray test was performed again and the tumor specificity was constructed.The cumulative incidence curve of death showed that there was no statistically significant difference in the risk of BCSS between patients undergoing breast-conserving surgery and those undergoing breast-conserving surgery(P>0.05).Conclusion: 1.For PSCCB patients,age,marital status,tumor T stage(any T with metastasis = M1 stage in tumor M stage),tumor N stage,and surgery are independent prognostic factors.2.The nomogram prediction model established in this study has good discrimination and fit,and can better predict OS after PSCCB patients.3.The risk stratification constructed based on the nomogram can assist clinicians in judging the individualized prognosis of patients.4.There is no difference in the effects of breast-conserving surgery and total breast resection on BCSS of breast squamous cell carcinoma.