Hwa Kyung Byun1, Jae Sik Kim2, Jee Suk Chang3, Yeona Cho3, Sung-Ja Ahn4, Jung Han Yoon5, Haeyoung Kim6, Nalee Kim6, Euncheol Choi7, Hyeli Park8, Kyubo Kim9, Shin-Hyung Park10, Chai Hong Rim11, Hoon Sik Choi12, Yoon Kyeong Oh13, Ik Jae Lee1, Kyung Hwan Shin14, Yong Bae Kim15. 1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. 2. Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. 3. Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 4. Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea. 5. Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea. 6. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 7. Department of Radiation Oncology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea. 8. Department of Radiation Oncology, Presbyterian Medical Center, Jeonju, South Korea. 9. Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, South Korea. 10. Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, South Korea. 11. Department of Radiation Oncology, Korea University Medical College, Seoul, South Korea. 12. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea. 13. Department of Radiation Oncology, Chosun University Medical School, Gwangju, South Korea. 14. Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. shin.kyunghwan@gmail.com. 15. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. ybkim3@yuhs.ac.
Abstract
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/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. CONCLUSION: This 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.
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/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. CONCLUSION: This 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.
Authors: Hwa Kyung Byun; Jee Suk Chang; Sang Hee Im; Youlia M Kirova; Alexandre Arsene-Henry; Seo Hee Choi; Young Up Cho; Hyung Seok Park; Jee Ye Kim; Chang-Ok Suh; Ki Chang Keum; Joo Hyuk Sohn; Gun Min Kim; Ik Jae Lee; Jun Won Kim; Yong Bae Kim Journal: Ann Surg Date: 2021-07-01 Impact factor: 12.969
Authors: Jane M Armer; Karla V Ballman; Linda McCall; Pamela L Ostby; Eris Zagar; Henry M Kuerer; Kelly K Hunt; Judy C Boughey Journal: JAMA Surg Date: 2019-09-01 Impact factor: 14.766
Authors: H Sackey; A Magnuson; K Sandelin; G Liljegren; L Bergkvist; Z Fülep; F Celebioglu; J Frisell Journal: Br J Surg Date: 2014-03 Impact factor: 6.939