A novel prognostic nomogram for predicting risks of distant failure in patients with invasive breast cancer following postoperative adjuvant radiotherapy

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Abstract

Purpose This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer. Materials and Methods A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model. Results The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (≥ 45 years vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029). Conclusion The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.

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Lim, Y. J., Lee, S. W., Choi, N., Kwon, J., Eom, K. Y., Kang, E., … Kim, I. A. (2018). A novel prognostic nomogram for predicting risks of distant failure in patients with invasive breast cancer following postoperative adjuvant radiotherapy. Cancer Research and Treatment, 50(4), 1140–1148. https://doi.org/10.4143/crt.2017.508

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