ArticleGland surgery2025
Development and validation of nomograms predicting survival in female patients with HER2-positive T1-3N0-1 breast cancer following breast-conserving surgery: a Surveillance, Epidemiology, and End Results database analysis.
Article in Gland surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite advances in human epidermal growth factor receptor 2 (HER2)-targeted therapies, HER2-positive early-stage breast cancer (BC) exhibits substantial outcome heterogeneity after breast-conserving surgery (BCS), complicating personalized chemotherapy sequencing. Robust tools integrating clinicopathological variables and treatment response are urgently needed to optimize survival while minimizing overtreatment. This study aimed to develop and validate a novel prognostic tool for this specific patient population. Methods: Using Surveillance, Epidemiology, and End Results (SEER) data [2010-2016; HER2-positive T1-3N0-1 BC patients (n=13,875) treated with BCS and radiotherapy], we developed and validated nomograms predicting overall and cancer-specific survival (CSS). Multivariable Cox regression identified prognostic factors, with nomogram performance evaluated via concordance index (C-index), time-dependent area under the curve (AUC), calibration, and decision curve analysis (DCA). Risk stratification used X-tile-derived thresholds. Results: Key independent predictors included tumor sequence [multiple primaries: overall survival (OS) hazard ratio (HR) =2.70], T stage (T2/T3: OS HR =1.79), nodal involvement (N1: OS HR =1.51), marital status (unmarried: OS HR =1.81), and chemotherapy administration (protective OS HR =0.44). Nomograms significantly outperformed American Joint Committee on Cancer (AJCC) 7th staging (OS C-index: 0.72 Conclusions: We present the first validated nomograms integrating tumor multiplicity, sociodemographic factors, and treatment response for HER2-positive BC. "Multiple primary tumors" emerged as a novel prognostic indicator, suggesting unexplored biological aggression. Our risk stratification translates to actionable strategies: chemotherapy de-escalation may be warranted in low-risk patients, as they derive no clear CSS benefit from NAC. Conversely, patients within the high-risk category are more likely to benefit from NAC and should be prioritized for this treatment to maximize survival gains. Prospective integration of targeted therapy data will refine these precision oncology tools.
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