Validation of a nomogram for predicting the risk of lymphedema following contemporary treatment for breast cancer: a large multi-institutional study (KROG 20-05)

淋巴水肿 列线图 医学 乳腺癌 乳房切除术 体质指数 队列 放射治疗 肿瘤科 外科 继发性淋巴水肿 内科学
作者
Hwa Kyung Byun,Jee Ye Kim,Jee Suk Chang,Young Up Cho,Sung-Ja Ahn,Jung Han Yoon,Hyun Yul Kim,Nalee Kim,Euncheol Choi,Hyung Seok Park,Kyubo Kim,Sungmin Park,Chai Hong Rim,Hoon Sik Choi,Yoon Kyeong Oh,Ik Jae Lee,Kyung Hwan Shin,Young Seok Kim
出处
期刊:Breast Cancer Research and Treatment [Springer Science+Business Media]
标识
DOI:10.1007/s10549-021-06507-x
摘要

PurposeWe previously constructed a nomogram for predicting the risk of arm lymphedema following contemporary breast cancer treatment. This nomogram should be validated in patients with different background characteristics before use. Therefore, we aimed to externally validate the nomogram in a large multi-institutional cohort.MethodsOverall, 8835 patients who underwent breast cancer surgery during 2007–2017 were identified. Data of variables in the nomogram and arm lymphedema were collected. The nomogram was validated externally using C-index and integrated area under the curve (iAUC) with 1000 bootstrap samples and by calibration plots.ResultsOverall, 1377 patients (15.6%) developed lymphedema. The median time from surgery to lymphedema development was 11.4 months. Lymphedema rates at 2, 3, and 5 years were 11.2%, 13.1%, and 15.6%, respectively. Patients with lymphedema had significantly higher body mass index (median, 24.1 kg/m2 vs. 23.4 kg/m2) and a greater number of removed nodes (median, 17 vs. 6) and more frequently underwent taxane-based chemotherapy (85.7% vs. 41.9%), total mastectomy (73.1% vs. 52.1%), conventionally fractionated radiotherapy (71.9% vs. 54.2%), and regional nodal irradiation (70.7% vs 22.4%) than those who did not develop lymphedema (all P < 0.001). The C-index of the nomogram was 0.7887, and iAUC was 0.7628, indicating good predictive accuracy. Calibration plots confirmed that the predicted lymphedema risks were well correlated with the actual lymphedema rates.ConclusionThis nomogram, which was developed using factors related to multimodal breast cancer treatment and was validated in a large multi-institutional cohort, can well predict the risk of breast cancer-related lymphedema.
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