ABSTRACT
BACKGROUND: The associations between socioeconomic statuses and survival outcomes of breast cancer remain unclear. No model has included both histological and socioeconomic factors to predict the survival of breast cancer. This study was designed to develop nomograms to predict breast cancer-specific survival (BCSS) and overall survival (OS) with consideration of socioeconomic factors for breast cancer patients. MATERIALS AND METHODS: We included a total of 207 749 female patients, diagnosed with malignant breast cancer between 2007 and 2012 from the Surveillance, Epidemiology, and End Results database. BCSS and OS were evaluated with Gray's test and log-rank tests, respectively. Marital statuses, insurance statuses, residence, median household income, poverty rate, unemployment rate, and education level were included as socioeconomic factors in univariate and multivariate Cox regression analyses. Clinicopathological factors and socioeconomic factors were integrated to construct nomograms. Calibration plots and concordance indexes (C-indexes) were used to evaluate the accuracy and discrimination of the models. RESULTS: Four and three socioeconomic factors were involved in constructing the nomograms for 3-, 5-, and 7-year BCSS and OS, respectively. The C-indexes of the final nomograms were higher than those of the TNM staging system for predicting BCSS (0.835 vs 0.782; P < .001) and OS (0.773 vs 0.676; P < .001). The performance of the nomograms for predicting OS was significantly lower when excluding socioeconomic factors (P < .001). CONCLUSION: These findings may highlight the importance of developing health-related policies and the necessity of targeted social support-based interventions for high-risk patients.
Subject(s)
Breast Neoplasms/mortality , Nomograms , Socioeconomic Factors , Adolescent , Adult , Age Factors , Aged , Breast Neoplasms/diagnosis , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SEER Program/statistics & numerical data , Social Support , United States/epidemiology , Young AdultABSTRACT
We evaluated the prognosis of the new grade groups and American Joint Committee on Cancer (AJCC) stage groups in men with prostate cancer (PCa) who were treated conservatively. A total of 13 798 eligible men were chosen from the Surveillance Epidemiology and End Results database. The new grade and AJCC stage groups were investigated on prostate biopsy specimens. Kaplan-Meier survival analysis and multivariable hazards models were applied to estimate the association of new grade and stage groups with overall survival (OS) and PCa-specific survival (CSS). Mean follow-up was 42.65 months (95% confidence interval: 42.47-42.84) in the entire cohort. The 3-year OS and CSS rates stepped down for grade groups 1-5 and AJCC stage groups I-IVB, respectively. After adjusting for clinical and pathological characteristics, all grade groups and AJCC stage groups were associated with higher all-cause and PCa-specific mortality compared to the reference group (all P ≤ 0.003). In conclusion, we evaluated the oncological outcome of the new grade and AJCC stage groups on biopsy specimens of conservatively treated PCa. These two novel clinically relevant classifications can assist physicians to determine different therapeutic strategies for PCa patients.
