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

Purpose We 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 larg...

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Published in:Breast cancer research and treatment 2022-04, Vol.192 (3), p.553-561
Main Authors: Byun, Hwa Kyung, Kim, Jae Sik, Chang, Jee Suk, Cho, Yeona, Ahn, Sung-Ja, Yoon, Jung Han, Kim, Haeyoung, Kim, Nalee, Choi, Euncheol, Park, Hyeli, Kim, Kyubo, Park, Shin-Hyung, Rim, Chai Hong, Choi, Hoon Sik, Oh, Yoon Kyeong, Lee, Ik Jae, Shin, Kyung Hwan, Kim, Yong Bae
Format: Article
Language:English
Subjects:
Body mass index
Breast cancer
Breast Neoplasms - surgery
Cancer
Cancer research
Cancer therapies
Chemotherapy
Clinical Trial
Drug therapy
Female
Health aspects
Humans
Lymphedema
Lymphedema - epidemiology
Lymphedema - etiology
Lymphedema - surgery
Mastectomy
Medicine
Medicine & Public Health
Nomograms
Oncology
Oncology, Experimental
Patients
Radiation therapy
Risk Factors
Surgery
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Summary:Purpose We 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. Methods Overall, 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. Results Overall, 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/m 2 vs. 23.4 kg/m 2 ) 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  
ISSN:0167-6806
1573-7217
DOI:10.1007/s10549-021-06507-x