Prognostic Factors Influencing Male Breast Cancer With Axillary Lymph Node Metastasis Based On SEER Database

Objective:With the increasing economic development,people’s living standard has improved significantly,but at the same time,the incidence of cancer has also increased.The incidence of breast cancer has replaced lung cancer as the first in the world,and the majority of the population is female,while the incidence of men is less than 1%.Therefore,the diagnosis and treatment of male breast cancer(MBC)is basically based on the treatment plan of female breast cancer.Both female and male breast cancers are prone to axillary lymph node metastasis,and the prognostic factors of female breast cancer with axillary lymph node metastasis have been thoroughly studied at home and abroad,while there is no uniform conclusion on the prognostic factors of male breast cancer with axillary lymph node metastasis due to the rarity of male breast cancer.Therefore,the precise treatment of male breast cancer with axillary lymph node metastasis is still difficult for clinicians.This study will examine the prognosis of MBC with axillary lymph node metastasis based on a large sample of data from the Surveillance,Epidemiology,and End Result database(SEER)of the National Cancer Institute(NCI).To investigate the prognostic factors of patients with axillary lymph node metastasis,and to provide a reference for individualized assessment and precise treatment of this group of patients.Methods:The complete data of patients with pathologically diagnosed male breast cancer with axillary lymph node metastasis from January 2010 to December 2015 in SEER data were extracted,including complete baseline data and survival data.Univariate analysis was performed using the Kaplan-Meier method to explore the effect of different variables on survival in patients with axillary lymph node metastasis in MBC,and was considered statistically significant when the P value was less than 0.05.Factors with statistically significant results in the univariate analysis were included in the multifactorial Cox regression analysis to identify independent prognostic influences in patients with axillary lymph node metastasis from MBC.The variables screened by the multifactorial analysis were used to construct the Nomogram prognostic prediction model using R language software,and the fit and discrimination of the column line graphs were examined using calibration curves and the concordance index(C-index).The total scores of patients were calculated and risk stratified into low-risk group,medium-risk group and high-risk group.Log-rank test was performed to evaluate the risk stratification ability of the model.Result:1.A total of 713 complete data of patients with MBC with axillary lymph node metastasis were included in the study,and the KM survival curves showed significant differences in survival rates between patients of different ages,races,clinical stages of AJCC,degree of tumor differentiation,size of tumor diameter,molecular typing,HER-2 status,radiotherapy,chemotherapy,and surgical treatment were available(all P values < 0.05).2.Multifactorial COX risk proportional regression analysis showed that advanced age(P < 0.001),large tumor diameter(P < 0.001),HER-2 positivity(P =0.032),and absence of chemotherapy(P = 0.005)were independent risk factors for patients with axillary lymph node metastasis in MBC.3.The prognostic prediction model for patients with axillary lymph node metastasis in MBC was constructed based on the above four independent influencing factors,and the consistency index(C-index)value of the prediction model was 0.769(95% CI: 0.730-0.808),which ranged from 0.5 to 1,suggesting that the constructed model has good discrimination.The calibration curves of the model predicting 1-year,3-year and 5-year OS were plotted and found to be close to the 45°diagonal(standard line),suggesting that the model predictions are in good agreement with the actual results.4.Through the calculation of the total score,the patients were divided into different risk groups,namely ≤7 into low risk group,8-10 into medium risk group,≥11 into high risk group.KM curve shows significant difference in survival rate of different risk wind layers,and P value of log-rank test is less than 0.0001,suggesting that the prediction model has certain risk stratification ability.Conclusion:1.After univariate analysis to draw KM survival curves,it showed that age,marital status,race,AJCC clinical stage,degree of tumor differentiation,tumor diameter size,molecular typing,HER-2 status,whether radiotherapy,whether chemot herapy,and surgical treatment status were prognostic influencing factors for axillary lymph node metastasis in male breast cancer,and there were significant differences in survival rates between different subgroups.2.Large tumor diameter,advanced age,and HER-2 positivity were independent risk factors for axillary lymph node metastasis in male breast cancer,and chemother apy was an independent protective factor.3.This Nomogram prognostic model constructed in this study has good differentiation and consistency,and can predict the 1-year,3-year and 5-year overall survival rates of male breast cancer patients with axillary lymph node metastasis,providing a reference for personalized and precise treatment.