Table_1_A Novel Nomogram Model to Identify Candidates and Predict the Possibility of Benefit From Primary Tumor Resection Among Female Patients With Metastatic Infiltrating Duct Carcinoma of the Breast: A Large Cohort Study.docx

BackgroundThe impact of primary site surgery on survival remains controversial in female patients with stage IV breast cancer. The purpose of this study was to investigate the role of primary tumor surgery in patients with stage IV breast cancer and concurrently develop a nomogram to identify which patients will benefit from surgery.
MethodsWe retrospectively searched the SEER database for female patients newly diagnosed with stage IV breast infiltrating duct carcinoma (BIDC) between 2010 and 2015 and then divided them into surgery and non-surgery groups. The propensity score matching (PSM) method was implemented to eliminate the bias, and Kaplan–Meier survival analysis was generated to compare the overall survival (OS) and cancer-specific survival (CSS) between the two groups. After PSM, Cox regression analyses were performed to determine the independent protective value of primary tumor surgery, while logistic regression analyses were utilized to uncover significant predictors of surgical benefit and establish a screening nomogram for female patients with stage IV BIDC. Nomogram performance was evaluated by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).
Result5,475 patients with stage IV BIDC were included in this study, and 2,375 patients (43.38%) received primary tumor surgery. After PSM, the median CSS was 53 months (95% CI: 46.84–59.16) in the surgery group compared with only 33 months (95% CI: 30.05–35.95) in the non-surgery group. We further found that primary tumor surgery was an independent protective factor for patients with stage IV BIDC. The independent factors affecting the benefit of locoregional surgery in patients with stage IV BIDC included histological grade, T stage, molecular subtype, lung metastasis, liver metastasis, brain metastasis, and marital status. The AUC of the nomogram was 0.785 in the training set and 0.761 in the testing set. The calibration curves and DCA confirmed that the nomogram could precisely predict the possibility of benefit from primary tumor resection.
ConclusionOur study suggested that primary tumor surgery improved the prognosis of female patients with stage IV BIDC and developed a nomogram to quantify the probability of surgical benefit to help identify surgical candidates clinically.

背景：对于IV期乳腺癌女性患者而言，原发灶手术对生存的影响仍存在争议。本研究旨在探讨原发肿瘤手术在IV期乳腺癌患者中的作用，并同步构建列线图（Nomogram）以识别可从手术中获益的患者。
方法：我们回顾性检索了SEER数据库中2010至2015年间新诊断为IV期乳腺浸润性导管癌（BIDC）的女性患者，并将其分为手术组与非手术组。采用倾向得分匹配（PSM）法消除偏倚，通过Kaplan-Meier生存分析比较两组患者的总生存期（OS）与肿瘤特异性生存期（CSS）。PSM后，采用Cox回归分析明确原发肿瘤手术的独立保护价值，同时利用logistic回归分析揭示手术获益的显著预测因子，并为IV期BIDC女性患者构建筛查用列线图。通过校准曲线、受试者工作特征（ROC）曲线及决策曲线分析（DCA）评估列线图的性能。
结果：本研究共纳入5475例IV期BIDC患者，其中2375例（43.38%）接受了原发肿瘤手术。PSM后，手术组的中位CSS为53个月（95%置信区间：46.84~59.16），而非手术组仅为33个月（95%置信区间：30.05~35.95）。我们进一步发现，原发肿瘤手术是IV期BIDC患者的独立保护因素。影响IV期BIDC患者局部区域手术获益的独立因素包括组织学分级、T分期、分子亚型、肺转移、肝转移、脑转移及婚姻状况。该列线图在训练集的曲线下面积（AUC）为0.785，在测试集为0.761。校准曲线与决策曲线分析证实，该列线图可精准预测患者从原发肿瘤切除术中获益的可能性。
结论：本研究表明，原发肿瘤手术可改善IV期BIDC女性患者的预后，并构建了列线图以量化手术获益概率，从而辅助临床识别手术适应证患者。