ABSTRACT
Purpose: The prognosis of patients with metastatic breast cancer usually varies greatly among individuals. At present, the application of nomogram is very popular in metastatic tumors. The present study was conducted to identify independent survival predictors and construct nomograms among young women with breast cancer bone metastasis (BCBM). Patients and Methods: We searched the Surveillance, Epidemiology, and End Results (SEER) database to identify young women diagnosed with BCBM between 2010 and 2016. We first analyzed the potential risk factors of overall survival (OS) and cancer-specific survival (CSS) by applying univariate Cox regression analysis. Then we conducted multivariate Cox analysis to identify independent survival predictors. Based on significant independent predictors, we developed and validated novel prognostic nomograms by using the R version 4.1.0 software. Results: We finally identified 715 eligible young women with BCBM for survival analysis, of which 358 patients were in the training set, and 357 patients in the validation set. Approximately four-fifths of patients are between 31 and 40 years old. The 5-year OS and CSS rates of this research population were 41.9 and 43.3%, respectively. Multivariate analysis revealed seven independent predictors of both OS and CSS, including race, tumor subtype, tumor size, surgical treatment, brain metastasis, liver metastasis, and lung metastasis. Based on these predictors, we developed and validated OS and CSS nomograms. The C-index of the OS nomogram reached 0.728 and 0.73 in the training and validation sets, respectively. The C-index of the CSS nomogram reached 0.743 and 0.695 in the training and validation sets, respectively. Meanwhile, high quality calibration plots were revealed in both OS and CSS nomograms. Conclusion: The current novel nomograms can provide an individualized survival evaluation of young women with BCBM and instruct clinicians to treat them appropriately.
ABSTRACT
BACKGROUND: Sarcopenia has been found to affect the postoperative outcomes of lumbar surgery. The effect of sarcopenia on the clinical outcomes in patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) has not yet been examined. OBJECTIVE: To investigate whether sarcopenia affects the Oswestry Disability Index (ODI) and visual analog scale (VAS) score for back pain following single-level stand-alone LLIF. METHODS: Patients who underwent a single level stand-alone LLIF for lumbar diseases were retrospectively investigated. Sarcopenia was defined according to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. Patients were divided into the sarcopenia (SP) and non-sarcopenia (NSP) group. Univariate analysis was used to compare with regards to demographics and clinical outcomes. Multivariate logistic regression was performed to elucidate factors predicting poor clinically improvement. RESULTS: Sixty-nine patients were enrolled, with 16 and 53 patients in the SP and NSP group respectively. In the SP group, patients were much older (P= 0.002), their body mass index was significantly lower (P< 0.001), the percent of women was higher (P= 0.042), and the skeletal muscle mass index (SMI) (P< 0.001) and gait speed were much lower (P= 0.005). The postoperative ODI scores were much higher and the improvement rate was much lower (both P< 0.001) in the SP group, whereas VAS scores for back pain showed no difference between the two groups. SMI and gait speed had a moderate and weak correlation with the final ODI score, respectively. Low SMI and low gait speed were independently associated with poor clinical outcomes at the final follow-up. CONCLUSIONS: Sarcopenia impacts the final clinical outcomes of stand-alone LLIF for lumbar diseases. Low SMI and low gait speed were negative impact factors for the clinical improvement after stand-alone LLIF.
