A Nomogram Predicting Survival in Patients with Breast Ductal Carcinoma in Situ with Microinvasion

Abstract Background: Ductal carcinoma in situ with microinvasion (DCISM) can be challenging to balance the risks of overtreatment versus undertreatment. We aim to identify prognostic factors in patients with DCISM and construct a nomogram to predict breast cancer-specific survival (BCSS).Methods: Women diagnosed with DCISM were selected from the Surveillance, Epidemiology and End Results database (1998-2015). Clinical variables and tumor characteristics were evaluated and Cox proportional-hazards regression model was performed. A nomogram was con­structed from the multivariate logistic regression model to combine all the prognostic factors to predict the prognosis of DCISM patients at 5 years, 10 years, and 15 years. Results: We identified 5,438 total eligible breast cancer patients with a median and max survival time of 78 and 227 months, respectively. Here, patients with poorer survival outcomes were those diagnosed between 1988-2001, African-American race, under 40 years of age, higher tumor N stage, progesterone receptor-negative tumor, and received no surgery (all P < 0.05). The nomogram was constructed by the seven variables and passed the calibration and validation steps. The area under the receiver operating characteristic (ROC) curve (AUC) of both the training set and the validating set (5-year AUC: 0.77 and 0.88, 10-year AUC: 0.75 and 0.73, 15-year AUC: 0.72 and 0.65) demonstrated excellent reliability and robust performance.Conclusion: Our current study is the first to construct nomograms of patients with DCISM which could help physicians identify breast cancer patients that more likely to benefit from more intensive treatment and follow-up.