Predicting Overall Survival in Patients with Male Breast Cancer: Nomogram Development and External Validation Study
Bibliographic record
Abstract
Background: Male breast cancer (MBC) is an uncommon disease. Few studies have discussed the prognosis of MBC due to its rarity. Objective: This study aimed to develop a nomogram to predict the overall survival of patients with MBC and externally validate it using cases from China. Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) database, male patients who were diagnosed with breast cancer between January 2010, and December 2015, were enrolled. These patients were randomly assigned to either a training set (n=1610) or a validation set (n=713) in a 7:3 ratio. Additionally, 22 MBC cases diagnosed at the First Affiliated Hospital of Guangxi Medical University between January 2013 and June 2021 were used for external validation, with the follow-up endpoint being June 10, 2023. Cox regression analysis was performed to identify significant risk variables and construct a nomogram to predict the overall survival of patients with MBC. Information collected from the test set was applied to validate the model. The concordance index (C-index), receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and a Kaplan-Meier survival curve were used to evaluate the accuracy and reliability of the model. Results: A total of 2301 patients with MBC in the SEER database and 22 patients with MBC from the study hospital were included. The predictive model included 7 variables: age (hazard ratio [HR] 1.89, 95% CI 1.50-2.38), surgery (HR 0.38, 95% CI 0.29-0.51), marital status (HR 0.75, 95% CI 0.63-0.89), tumor stage (HR 1.17, 95% CI 1.05-1.29), clinical stage (HR 1.41, 95% CI 1.15-1.74), chemotherapy (HR 0.62, 95% CI 0.50-0.75), and HER2 status (HR 2.68, 95% CI 1.20-5.98). The C-index was 0.72, 0.747, and 0.981 in the training set, internal validation set, and external validation set, respectively. The nomogram showed accurate calibration, and the ROC curve confirmed the advantage of the model in clinical validity. The DCA analysis indicated that the model had good clinical applicability. Furthermore, the nomogram classification allowed for more accurate differentiation of risk subgroups, and patients with low-risk MBC demonstrated substantially improved survival outcomes compared with medium- and high-risk patients (P<.001). Conclusions: A survival prognosis prediction nomogram with 7 variables for patients with MBC was constructed in this study. The model can predict the survival outcome of these patients and provide a scientific basis for clinical diagnosis and treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".