Development and Validation of Nomograms for Predicting the Prognosis of Triple-Negative Breast Cancer Patients Based on 379 Chinese Patients

Abstract

Purpose

We aimed to construct universally applicable nomograms incorporating prognostic factors to predict the prognosis of patients with triple-negative breast cancer (TNBC).

Patients and methods

Clinicopathological data of 379 patients with TNBC from March 2008 to June 2014 were retrospectively collected and analyzed. The endpoints were disease-free survival (DFS) and overall survival (OS). Patients were randomly divided into a training group and an independent validation group. In the training group, the prognostic factors were screened to develop nomograms. C-index and calibration curves were used to evaluate the predictive accuracy and discriminative ability of nomograms in both groups. The accuracy of the nomograms was also compared with the traditional American Joint Committee on Cancer Tumor-Node-Metastasis anatomical stage (8th edition).

Results

Four prognostic factors (albumin-to-globulin ratio, neutrophil-to-lymphocyte ratio, positive lymph nodes, and tumor size) were used to construct the nomogram of DFS. In addition to the aforementioned factors, age was taken into account in the construction of the OS nomogram. The C-index of the DFS nomogram in the training and validation groups was 0.71 (95% confidence interval [CI]: 0.64–0.77) and 0.69 (95% CI: 0.58–0.79), respectively; the C-index of the OS nomogram was 0.77 (95% CI: 0.70–0.84) and 0.74 (95% CI: 0.62–0.86), respectively. This suggests that the nomograms had high accuracy. Moreover, calibration curves showed good consistencies in both groups. Our models showed superiority in predicting accuracy compared with the AJCC TNM staging system. Furthermore, two web pages of the nomograms were produced: DFS: https://sh-skipper.shinyapps.io/TNBC1/; OS: https://sh-skipper.shinyapps.io/TNBC2/.

Conclusion

These predictive models are simple and easy to use, particularly the web versions. They have certain clinical value in predicting the prognosis of patients with TNBC. They can assist doctors in identifying patients at different prognostic risks and strengthen the treatment or follow-up accordingly.

Keywords:

• triple negative breast cancer
• prognosis
• prediction
• nomograms

Acknowledgements

We thank Charlesworth Author Services for English language editing. This study was funded by Wenzhou Municipal Science and Technology Bureau Foundation (Y20170038) and Department of Health Foundation of Zhejiang Province (2019KY454).

Data Sharing Statement

The dataset in this study is available by request from the corresponding author; for more information, please contact the corresponding author.

Ethics Approval and Informed Consent

The present study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Wenzhou Medical University and conformed to the provisions of the Declaration of Helsinki in 1995 (as revised in Edinburgh 2000). Owing to the retrospective nature of the study, a waiver for the requirement of individual informed consent was granted by the institutional ethics committee. We confirmed that the data were anonymized and analyzed with confidentiality.

Disclosure

The authors report no conflicts of interest in this work.