4. Discussion
TNBC, bleeding, moderate-risk, pain
REGRESSION, BLEEDING, METASTASIS, STAGE IV BREAST CANCER, POSTOPERATIVE COMPLICATIONS, ULCERATION, PRIMARY TUMOR, METASTATIC BREAST CANCER
Traditionally, surgical intervention at the primary tumor site has been employed as a palliative strategy to manage localized symptoms in patients with metastatic breast cancer, including issues like ulceration, bleeding, or pain. Based on prior research, the excision of the primary tumor has been associated with a mortality reduction ranging from 18% to 37% [In this study, we analyzed clinicopathological and treatment characteristics of dnMBC patients who underwent IBR using data from the SEER database. We employed three methods, including univariate Cox regression, BSR, and LASSO, to progressively establish a backward stepwise multivariate Cox regression model, with the aim of avoiding overfitting and underfitting. After comparing the AUC and AIC values of various models, we ultimately constructed a predictive model based on variables identified through univariate and multivariate Cox regression, presenting it as a nomogram for reference by surgeons. Then, we conducted a rigorous validation of the nomogram using diverse statistical methods and the model demonstrated excellent predictive performance for BCSS. In addition to the nomogram, this research has devised a risk stratification system that classifies the target population into three prognostic groups, visually integrated into the nomogram for presentation. The prognostic risk prediction model could assist the counseling of patients about reconstruction options and risk versus benefit considerations.De novo metastatic breast cancer demonstrates a high degree of heterogeneity, manifesting in various aspects such as demographic variables, genetic profiles, molecular subtypes, and patterns of metastasis, leading to considerable variability in the prognostic outcomes of patients [This research indicates a notably superior breast cancer-specific survival among patients aged ≤50 who underwent IBR, in contrast to the population aged >50. Prior studies have demonstrated that among metastatic breast cancer patients who underwent surgery, younger age (HR 0.3; However, patients with TNBC tend to have a poorer prognosis regardless of their age [Postmastectomy radiotherapy significantly improves the survival of stage IV breast cancer patients [The developed nomogram in this study enables a more precise prediction of prognosis risk for de novo MBC patients undergoing IBR. Surgeons can use the scoring criteria within the nomogram to assign scores to each clinical or treatment characteristic of advanced breast cancer patients expressing an intention for IBR. Based on the sum of the patient’s risk scores, corresponding 1-year, 3-year, and 5-year BCSS can be determined. Additionally, the risk stratification model facilitates the identification of high-risk patients. In practical clinical settings, this predictive model serves as a valuable tool, aiding surgeons in making well-informed decisions and preventing the oversight of valuable immediate reconstruction opportunities for certain low- or moderate-risk patients.This study has several limitations: Firstly, the inherent retrospective nature of this research introduces a potential selection bias. Secondly, details regarding radiotherapy, chemotherapy, and other systemic treatments such as hormonal or targeted therapies was unavailable from the SEER database. Thirdly, data regarding postoperative complications and patient-reported outcomes in cases undergoing IBR could not be obtained from the SEER database. Fourthly, the predictive model established in this study necessitates further validation with external datasets or real-world data.