title: A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study.
abstract: Axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) alone may lead to postoperative complications. Among patients with positive ALN in the preoperative examination, approximately 40% patients do not have SLN metastasis. Herein, we aimed to develop a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. We retrospectively analyzed the clinicopathological features of 4211 female patients with breast cancer who were diagnosed in seven breast cancer centers representing entire China, over 10 years (1999-2008). The patients were randomly categorized into a training cohort or validation cohort (3:1 ratio). Multivariate logistic regression analysis was performed for 1869 patients with complete information on the study variables. Age at diagnosis, tumor size, tumor quadrant, clinical nodal status, local invasion status, pathological type, and molecular subtypes were the independent predictors of ALN metastasis. The nomogram was then developed using the seven variables. Further, it was subsequently validated in 642 patients with complete data on variables in the validation cohort. Coefficient of determination (R²) and the area under the receiver-operating characteristic (ROC) curve (AUC) were calculated to be 0.979 and 0.7007, showing good calibration and discrimination of the model, respectively. The false-negative rates of the nomogram were 0 and 6.9% for the predicted risk cut-off values of 14.03% and 20%, respectively. Therefore, when the predicted risk is less than 20%, SLNB may be avoided. After further validation in various patient populations, this model may support increasingly limited axillary surgery in breast cancer.
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.|Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China.
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R. China.
authors.forename: Wei-Liang
authors.initials: WL
authors.lastname: Feng
authors.affiliation: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China.
authors.forename: Ya-Nan
authors.initials: YN
authors.lastname: Kong
authors.affiliation: Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha, P.R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, P.R. China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: Qing-Kun
authors.initials: QK
authors.lastname: Song
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: Bao-Ning
authors.initials: BN
authors.lastname: Zhang
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: Jin-Hu
authors.initials: JH
authors.lastname: Fan
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.affiliation: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Xie
authors.affiliation: Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: He
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D002681:China / Q000453:epidemiology; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049451:Nomograms; D012372:ROC Curve; D011897:Random Allocation; D021701:Sentinel Lymph Node Biopsy
keywords: axillary lymph node metastasis; breast cancer; nomogram; prediction model