Development of a nomogram to predict overall survival among non-metastatic breast cancer patients in China:a retrospective multicenter study

The accurate prediction of overall survival(OS)is important in clinical decision-making for breast cancer treatment.We developed a model to predict the OS of non-metastatic breast cancer patients in China.This multicenter study included 1844 non-metastatic breast cancer patients who underwent breast cancer surgery between January 2009 and December 2011 in 3 tertiary teaching hospitals in China.Data were collected retrospectively from the database of each hospital.We used univariate and multivariate Cox proportional hazard regression analyses to screen for predictors.A nomogram was developed in the training cohort(from Sun Yatsen Memorial Hospital[SYSMH]),externally validated in 2 validation cohorts(from the First People’s Hospital of Foshan[FPHF]and Sun Yat-sen University Cancer Center(SYUCC)),and compared with CancerMath,a mathematical-based model.We used Receiver Operating Characteristic curves and calibration plots to assess the models.At median follow-ups of 65.9,68.6,and 66.2 months,the 5-year OS rates were 93.0%,86.7%,and 91.0%in the SYSMH,FPHF,and SYUCC cohorts,respectively.We identified age,T stage,lymph node status,estrogen receptor,and human epidermal growth factor receptor 2 statuses as significant prognostic factors.A nomogram was developed and externally validated in the FPHF(area under the curve=0.74)and SYUCC(area under the curve=0.77)cohorts.Calibration plots showed that the predicted OS was consistent with the actual OS.The nomogram outperformed CancerMath in our study population.In summary,we developed a nomogram to predict survival among non-metastatic breast cancer patientsin China.This nomogram is superior to the CancerMath model in Chinese populations.