Survival analysis of recurrent breast cancer patients using mix Bayesian network

Introduction

Breast cancer (BC) is the most common cancer among women. Iranians have an 11% BC recurrence rate, which lowers their survival rates. Few studies have investigated cancer recurrence survival rates. This study's major purpose is to use a mixed Bayesian network (BN) to analyze recurrent patients' survival.

Material and methods

This study aimed to evaluate the pathobiological features, age, gender, final status, and survival time of the patients. Bayesian imputation was used for missing data. The performance of BN was optimized through the utilization of a blacklist and prior probability. After structural and parametric learning, posterior conditional probabilities and mean survival periods for the node arcs were predicted. The hold-out technique based on the posterior classification error was used to investigate the model's validation.

Results

The study included 220 cancer recurrence patients. These patients averaged 47 years old. The BN with a blacklist and prior probability has a higher network score than other networks. The hold-out technique verified structural learning. The Directed Acyclic Graph showed a statistically significant relationship between cancer biomarkers (ER, PR, and HER2 receptors), cancer stage, and tumor grade and patient survival duration. Patient death was also significantly associated with education, ER, PR, HER2, and tumor grade. The BN reports that HER2 negative, ER positive, and PR positive patients had a higher survival rate.

Conclusion

Survival and death of relapsed patients depend on biomarkers. Based on the findings, patient survival can be predicted with their features.

Time-related survival prediction in molecular subtypes of breast cancer using time-to-event deep-learning-based models

Background

Breast cancer (BC) survival prediction can be a helpful tool for identifying important factors selecting the effective treatment reducing mortality rates. This study aims to predict the time-related survival probability of BC patients in different molecular subtypes over 30 years of follow-up.

Materials and methods

This study retrospectively analyzed 3580 patients diagnosed with invasive breast cancer (BC) from 1991 to 2021 in the Cancer Research Center of Shahid Beheshti University of Medical Science. The dataset contained 18 predictor variables and two dependent variables, which referred to the survival status of patients and the time patients survived from diagnosis. Feature importance was performed using the random forest algorithm to identify significant prognostic factors. Time-to-event deep-learning-based models, including Nnet-survival, DeepHit, DeepSurve, NMLTR and Cox-time, were developed using a grid search approach with all variables initially and then with only the most important variables selected from feature importance. The performance metrics used to determine the best-performing model were C-index and IBS. Additionally, the dataset was clustered based on molecular receptor status (i.e., luminal A, luminal B, HER2-enriched, and triple-negative), and the best-performing prediction model was used to estimate survival probability for each molecular subtype.

Results

The random forest method identified tumor state, age at diagnosis, and lymph node status as the best subset of variables for predicting breast cancer (BC) survival probabilities. All models yielded very close performance, with Nnet-survival (C-index=0.77, IBS=0.13) slightly higher using all 18 variables or the three most important variables. The results showed that the Luminal A had the highest predicted BC survival probabilities, while triple-negative and HER2-enriched had the lowest predicted survival probabilities over time. Additionally, the luminal B subtype followed a similar trend as luminal A for the first five years, after which the predicted survival probability decreased steadily in 10- and 15-year intervals.

Conclusion

This study provides valuable insight into the survival probability of patients based on their molecular receptor status, particularly for HER2-positive patients. This information can be used by healthcare providers to make informed decisions regarding the appropriateness of medical interventions for high-risk patients. Future clinical trials should further explore the response of different molecular subtypes to treatment in order to optimize the efficacy of breast cancer treatments.

Postdiagnosis dietary factors, supplement use and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

Little is known about how diet might influence breast cancer prognosis. The current systematic reviews and meta-analyses summarise the evidence on postdiagnosis dietary factors and breast cancer outcomes from randomised controlled trials and longitudinal observational studies. PubMed and Embase were searched through 31st October 2021. Random-effects linear dose-response meta-analysis was conducted when at least three studies with sufficient information were available. The quality of the evidence was evaluated by an independent Expert Panel. We identified 108 publications. No meta-analysis was conducted for dietary patterns, vegetables, wholegrains, fish, meat, and supplements due to few studies, often with insufficient data. Meta-analysis was only possible for all-cause mortality with dairy, isoflavone, carbohydrate, dietary fibre, alcohol intake and serum 25-hydroxyvitamin D (25(OH)D), and for breast cancer-specific mortality with fruit, dairy, carbohydrate, protein, dietary fat, fibre, alcohol intake and serum 25(OH)D. The results, with few exceptions, were generally null. There was limited-suggestive evidence that predefined dietary patterns may reduce the risk of all-cause and other causes of death; that isoflavone intake reduces the risk of all-cause mortality (relative risk (RR) per 2 mg/day: 0.96, 95% confidence interval (CI): 0.92-1.02), breast cancer-specific mortality (RR for high vs low: 0.83, 95% CI: 0.64-1.07), and recurrence (RR for high vs low: 0.75, 95% CI: 0.61-0.92); that dietary fibre intake decreases all-cause mortality (RR per 10 g/day: 0.87, 95% CI: 0.80-0.94); and that serum 25(OH)D is inversely associated with all-cause and breast cancer-specific mortality (RR per 10 nmol/L: 0.93, 95% CI: 0.89-0.97 and 0.94, 95% CI: 0.90-0.99, respectively). The remaining associations were graded as limited-no conclusion.

The Global and Regional Survival Rate of Women With Breast Cancer: A Systematic Review and Meta-analysis

Breast cancer is the most common cancer among women in the world. The aim of this study was to measure the global and regional survival rates of women with breast cancer. We searched Medline/PubMed, Web of Science, Scopus, and Google Scholar to identify cohort studies on the survival rate of women with primary invasive breast cancer until the end of June 2017. We used random effect models to estimate the pooled 1-, 3-, 5-, and 10-year survival rates. Subgroup analysis and meta-regression models were used to investigate the potential sources of heterogeneity. One hundred twenty-six studies were included in the meta-analysis. Between-study heterogeneities in the 1-, 3-, 5-, and 10-year survival rates were significantly high (all I²s > 50%; P = .001). The global 1-, 3-, 5-, and 10-year pooled survival rates in women with breast cancer were 0.92 (95% confidence interval [CI], 0.90-0.94), 0.75 (95% CI, 0.71-0.79), 0.73 (95% CI, 0.71-0.75), and 0.61% (95% CI, 0.54-0.67), respectively. Subgroup analysis revealed that survival rates varied in different World Health Organization regions, age and stage at diagnosis, year of the studies, and degree of development of countries. Meta-regression indicated that year of the study (β = 0.07; P = .002) and development of country (β = -0.1; P = .0001) were potential sources of heterogeneity. The survival rate was improved in recent decades; however, it is lower in developing regions than developed ones.

A Survey of the Prevalence and Impact of Reporting Guideline Endorsement in Pathology Journals

OBJECTIVES

To determine the prevalence of reporting guideline endorsement in pathology journals and to estimate the impact of guideline endorsement.

METHODS

We compared the quality of reporting in two sets of studies: (1) studies published in journals that explicitly mentioned a guideline vs studies published in journals that did not and (2) studies that cited a guideline vs studies that did not. The quality of reporting in prognostic biomarker studies was assessed using the REporting recommendations for tumor MARKer prognostic studies (REMARK) guideline.

RESULTS

We found that six (10%) of the 59 leading pathology journals explicitly mention reporting guidelines in the instructions to authors. Only one journal required authors to submit a checklist. There was significant variation in the rate at which various REMARK items were reported (P < .001). Journal endorsement was associated with more complete reporting (P = .04). Studies that cited REMARK had greater adherence to the REMARK reporting guidelines than studies that did not (P = .02).

CONCLUSIONS

The prevalence of guideline endorsement is relatively low in pathology journals, but guideline endorsement may improve the quality of reporting.

The overall 5-year survival rate of breast cancer among Iranian women: A systematic review and meta-analysis of published studies

INTRODUCTION

Breast Cancer (BC) is the most prevalent cancer and the second leading cause of cancer-related death among Iranian women. A valid estimation of the 5-year survival rate can improve the current BC treatment programs. The present study aimed to assess the 5-year survival rate through a systematic review of published studies.

METHODS

A systematic search of Medline/PubMed, Scopus, and Science direct as well as Iranian databases was conducted to identify the original articles evaluating the 5-year survival rate of BC among women in Iran. Random effects model was used to estimate the pooled 5-year survival rate. The eligible articles were analyzed using the Stata software.

RESULTS

Our comprehensive literature search identified 11 eligible articles 2 of which were excluded due to reporting the results of a single study. The remaining 9 articles that contained 4815 women diagnosed with BC during 1991-2014 were included in the meta-analysis. The combined 5-year survival rate of BC was estimated to be 67.60%.

DISCUSSION/CONCLUSION

The survival rate of BC was relatively low in Iran compared to developed countries. Hence, more effective measures have to be taken to increase these patients' survival.

Survival Rate of Breast Cancer in Iran: A Meta-Analysis

Background:

There has not been a general estimation about survival rates of breast cancer cases in Iran. Therefore, the present study aimed to assess survival using a meta-analysis.

Materials and Methods:

International credible databases such as Scopus, Web of Science, PubMed, Science direct and Google Scholar and Iranian databases such as Magiran, Irandoc and SID, from 1997 to 2015 were searched. All articles covering survival rate of breast cancer were entered into the study without any limits. Quality assessment of the articles and data extraction were performed by two researchers using the modified STROBE checklist, which includes 12 questions. Articles with scores greater than 8 were included in the analysis. A limitation of this meta-analysis was different methods for presenting of results in the papers surveyed.

Results:

A total of 21 articles with a sample of 12,195 people were analyzed. The one-year, three-year, five-year and ten-year survival rates of breast cancer in Iran were estimated to be 95.8% (94.6-97.0), 82.4% (79.0-85.8), 69.5% (64.5-74.5), 58.1% (39.6-76.6), respectively. The most important factors affecting survival of breast cancer were age, number of lymph nodes involved, size of the tumor and the stage of the disease.

Conclusion:

The five- and ten- year survival rates in Iran are lower than in developed countries. Conducting breast cancer screening plan support (including regular clinical examination, mammography), public training and raising awareness should be helpful in facilitating early diagnosis and increasing survival rates for Iranian women.