Cancer treatment and research communications · 2026
A predictive nomogram for cancer-specific survival in elderly patients with ductal carcinoma in situ after lumpectomy: A SEER-based retrospective study.
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Hongxia Hui, Honglei Luo, Yi Ren, Hua Liu, Yaqi Song
Аннотация
PURPOSE: To develop and validate a prognostic nomogram to predict cancer-specific survival (CSS) in elderly patients with ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS).
METHODS: Data from the SEER database (2000-2019) were used, comprising 40,502 eligible patients who were randomly assigned to training and validation cohorts. Cox proportional hazards and Fine-Gray competing risks regression models were employed. A nomogram was constructed and evaluated using time-dependent C-index, calibration curves, and decision curve analysis. Risk stratification and subgroup analyses were conducted.
RESULTS: Multivariable analysis identified older age (≥80 years; HR 1.85, 95% CI 1.53-2.24), hormone receptor negativity (HR 1.33, 95% CI 1.04-1.69), and omission of radiotherapy (HR 1.34, 95% CI 1.11-1.61) as independent predictors of worse CSS. The nomogram demonstrated moderate discriminative ability, with time-dependent C-indices of 0.606 (training) and 0.659 (validation). Calibration and decision curve analysis demonstrated favorable clinical utility. Subgroup analyses indicated a significant CSS benefit from radiotherapy among hormone receptor-negative patients across all age groups (70-79: HR 0.349, p < 0.001; ≥80: HR 0.375, p = 0.045).
CONCLUSIONS: We developed and validated a nomogram that integrates age, hormone receptor status, and radiotherapy use to predict CSS in older patients with DCIS following breast-conserving surgery. This tool could aid in identifying a high-risk patients, particularly those with hormone receptor-negative disease, who may derive significant survival benefit from adjuvant radiotherapy.
METHODS: Data from the SEER database (2000-2019) were used, comprising 40,502 eligible patients who were randomly assigned to training and validation cohorts. Cox proportional hazards and Fine-Gray competing risks regression models were employed. A nomogram was constructed and evaluated using time-dependent C-index, calibration curves, and decision curve analysis. Risk stratification and subgroup analyses were conducted.
RESULTS: Multivariable analysis identified older age (≥80 years; HR 1.85, 95% CI 1.53-2.24), hormone receptor negativity (HR 1.33, 95% CI 1.04-1.69), and omission of radiotherapy (HR 1.34, 95% CI 1.11-1.61) as independent predictors of worse CSS. The nomogram demonstrated moderate discriminative ability, with time-dependent C-indices of 0.606 (training) and 0.659 (validation). Calibration and decision curve analysis demonstrated favorable clinical utility. Subgroup analyses indicated a significant CSS benefit from radiotherapy among hormone receptor-negative patients across all age groups (70-79: HR 0.349, p < 0.001; ≥80: HR 0.375, p = 0.045).
CONCLUSIONS: We developed and validated a nomogram that integrates age, hormone receptor status, and radiotherapy use to predict CSS in older patients with DCIS following breast-conserving surgery. This tool could aid in identifying a high-risk patients, particularly those with hormone receptor-negative disease, who may derive significant survival benefit from adjuvant radiotherapy.