Prognostic assessment of mucinous breast carcinoma with micropapillary pattern: a prespecified cox analysis with exploratory DeepSurv modeling
Abstract
BackgroundMucinous breast carcinoma (MBC) is a rare histological type of breast cancer. Mucinous breast carcinoma with micropapillary pattern (MPMC) is defined by the presence of any micropapillary architecture. This retrospective cohort study aimed to evaluate the prognostic significance of the micropapillary pattern on disease-free survival in patients with mucinous breast carcinoma.MethodsWe conducted a retrospective analysis of all mucinous breast carcinoma cases diagnosed between 2005 and 2024. Clinicopathological parameters, treatment modalities, and survival outcomes were collected and analyzed. Prognostic factors were evaluated using a prespecified reduced Cox model as the primary analysis. Because limited DFS events occurred, all multivariable estimates were considered exploratory. DeepSurv was used as a supplementary exploratory analysis to capture potential nonlinear relationships.ResultsA total of 344 mucinous breast carcinoma cases were included, among which 65 patients (18.9%) exhibited micropapillary pattern. Kaplan–Meier analysis showed significantly worse disease-free survival in MPMC patients (11 events vs. 6 events), with 5-year disease-free survival (DFS) rates of 76.7% and 97.3%, respectively (p < 0.001). In the prespecified reduced Cox model, the micropapillary pattern was associated with worse DFS (HR 8.17; 95% CI 2.88–21.76; p < 0.001). However, because only 17 DFS events occurred, this estimate was imprecise and exploratory. In sensitivity analyses, the full model yielded HR 8.05 (95% CI 2.90–22.37) and Firth’s penalized likelihood correction yielded HR 10.74 (95% CI 3.52–32.83). Hypercellularity was also associated with worse DFS (HR 7.55; 95% CI 2.61–21.85). In the supplementary exploratory DeepSurv analysis, the model captured potential nonlinear relationships and achieved a C-index of 0.858, with AUCs of 0.804, 0.878, and 0.826 for 1-, 3-, and 5-year DFS, respectively, and a Brier score of 0.022. However, these performance estimates may be optimistic because only 17 DFS events occurred; DeepSurv was therefore considered exploratory and not clinically validated.ConclusionsMPMCs exhibit more aggressive tumor behavior and are associated with worse prognosis, with hypercellularity also identified as a significant poor prognostic factor. These findings suggest that MPMC may represent a higher-risk subgroup requiring closer surveillance. However, treatment implications should still be interpreted cautiously and require prospective validation.
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BibTeX
@article{wen2026prognostic,
title = {{Prognostic assessment of mucinous breast carcinoma with micropapillary pattern: a prespecified cox analysis with exploratory DeepSurv modeling}},
author = {Jiahuai Wen and Chen Fang and Yanning Yang and Xiaoqian Zhang and Mengling Kang and LeZhen Huang and Liping Ren},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1965948},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1965948},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prognostic assessment of mucinous breast carcinoma with micropapillary pattern: a prespecified cox analysis with exploratory DeepSurv modeling
AU - Jiahuai Wen
AU - Chen Fang
AU - Yanning Yang
AU - Xiaoqian Zhang
AU - Mengling Kang
AU - LeZhen Huang
AU - Liping Ren
PY - 2026
DA - 2026/11/13
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1965948
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1965948
AB - BackgroundMucinous breast carcinoma (MBC) is a rare histological type of breast cancer. Mucinous breast carcinoma with micropapillary pattern (MPMC) is defined by the presence of any micropapillary architecture. This retrospective cohort study aimed to evaluate the prognostic significance of the micropapillary pattern on disease-free survival in patients with mucinous breast carcinoma.MethodsWe conducted a retrospective analysis of all mucinous breast carcinoma cases diagnosed between 2005 and 2024. Clinicopathological parameters, treatment modalities, and survival outcomes were collected and analyzed. Prognostic factors were evaluated using a prespecified reduced Cox model as the primary analysis. Because limited DFS events occurred, all multivariable estimates were considered exploratory. DeepSurv was used as a supplementary exploratory analysis to capture potential nonlinear relationships.ResultsA total of 344 mucinous breast carcinoma cases were included, among which 65 patients (18.9%) exhibited micropapillary pattern. Kaplan–Meier analysis showed significantly worse disease-free survival in MPMC patients (11 events vs. 6 events), with 5-year disease-free survival (DFS) rates of 76.7% and 97.3%, respectively (p < 0.001). In the prespecified reduced Cox model, the micropapillary pattern was associated with worse DFS (HR 8.17; 95% CI 2.88–21.76; p < 0.001). However, because only 17 DFS events occurred, this estimate was imprecise and exploratory. In sensitivity analyses, the full model yielded HR 8.05 (95% CI 2.90–22.37) and Firth’s penalized likelihood correction yielded HR 10.74 (95% CI 3.52–32.83). Hypercellularity was also associated with worse DFS (HR 7.55; 95% CI 2.61–21.85). In the supplementary exploratory DeepSurv analysis, the model captured potential nonlinear relationships and achieved a C-index of 0.858, with AUCs of 0.804, 0.878, and 0.826 for 1-, 3-, and 5-year DFS, respectively, and a Brier score of 0.022. However, these performance estimates may be optimistic because only 17 DFS events occurred; DeepSurv was therefore considered exploratory and not clinically validated.ConclusionsMPMCs exhibit more aggressive tumor behavior and are associated with worse prognosis, with hypercellularity also identified as a significant poor prognostic factor. These findings suggest that MPMC may represent a higher-risk subgroup requiring closer surveillance. However, treatment implications should still be interpreted cautiously and require prospective validation.
SN - 2234-943X
ER -