Background: Metastatic triple-negative breast cancer (TNBC) is aggressive with poor median overall survival (OS) ranging from 8 to 13 months. There exists considerable heterogeneity in survival at the individual patient level. To better understand the survival heterogeneity and improve risk stratification, our study aims to identify the factors influencing survival, utilizing a large patient sample from the National Cancer Database (NCDB). Methods: Women diagnosed with metastatic TNBC from 2010 to 2020 in the NCDB were included. Demographic, clinicopathological, and treatment data and overall survival (OS) outcomes were collected. Kaplan–Meier curves were used to estimate OS. The log-rank test was used to identify OS differences between groups for each variable in the univariate analysis. For the multivariate analysis, the Cox proportional hazard model with backward elimination was used to identify factors affecting OS. Adjusted hazard ratios and 95% confidence intervals are presented. Results: In this sample, 2273 women had a median overall survival of 13.6 months. Factors associated with statistically significantly worse OS included older age, higher comorbidity scores, specific histologies, higher number of metastatic sites, presence of liver or other site metastases in those with only one metastatic site (excluding brain metastases), presence of cranial and extra-cranial metastases, lack of chemotherapy, lack of immunotherapy, lack of surgery to distant sites, lack of radiation to distant sites, and receipt of palliative treatment to alleviate symptoms. In the multivariate analysis, comorbidity score, histology, number of metastatic sites, immunotherapy, and chemotherapy had a statistically significant effect on OS. Conclusions: Through NCDB analysis, we have identified prognostic factors for metastatic TNBC. These findings will help individualize prognostication at diagnosis, optimize treatment strategies, and facilitate patient stratification in future clinical trials.
背景：转移性三阴性乳腺癌（TNBC）具有侵袭性，中位总生存期（OS）较差，范围在8至13个月之间。在个体患者层面，生存情况存在显著异质性。为更好地理解生存异质性并改善风险分层，本研究旨在利用美国国家癌症数据库（NCDB）的大样本患者数据，识别影响生存的因素。方法：研究纳入2010年至2020年间NCDB中诊断为转移性TNBC的女性患者。收集人口统计学、临床病理学、治疗数据及总生存期（OS）结果。采用Kaplan-Meier曲线估计OS，单变量分析中使用对数秩检验识别各变量组间OS差异。多变量分析采用向后剔除法的Cox比例风险模型，以确定影响OS的因素，并给出调整后的风险比及95%置信区间。结果：本样本包含2273名女性患者，中位总生存期为13.6个月。与OS显著较差相关的因素包括：年龄较大、合并症评分较高、特定组织学类型、转移部位数量较多、在仅有一个转移部位（排除脑转移）的情况下存在肝脏或其他部位转移、同时存在颅内外转移、未接受化疗、未接受免疫治疗、未对远处转移灶进行手术、未对远处转移灶进行放疗，以及接受缓解症状的姑息治疗。多变量分析显示，合并症评分、组织学类型、转移部位数量、免疫治疗和化疗对OS具有统计学显著影响。结论：通过NCDB分析，我们确定了转移性TNBC的预后因素。这些发现将有助于在诊断时个体化评估预后、优化治疗策略，并为未来临床试验中的患者分层提供依据。
肿瘤(癌症)患者之家