Development and Validation of a Nomogram for Predicting Axillary Lymph Node Metastasis in Breast Cancer

Abstract

BackgroundAxillary lymph node (ALN) status is a key prognosis indicator for breast cancer patients. To develop an effective tool for predicting axillary lymph node metastasis in breast cancer, a nomogram was established based on mRNA expression data and clinicopathological characteristics. Materials and MethodsA 1062 breast cancer patients with mRNA data and clinical information were obtained from The Cancer Genome Atlas (TCGA). We first analyzed the differentially expression genes (DEGs) between ALN positive and ALN negative patients. Then, logistic regression, least absolute shrinkage and selection operator (Lasso) regression, and backward stepwise regression were performed to select candidate mRNA biomarkers. The mRNA signature was constructed by the mRNA biomarkers and corresponding Lasso coefficients. The key clinical factors were obtained by Wilcoxon-Mann-Whitney U test or Pearson's χ2 test. Finally, the nomogram for predicting axillary lymph node metastasis was developed and evaluated by concordance index (C-index), calibration curve, decision curve analysis (DCA), and receptor operating characteristic (ROC) curve. Furthermore, the nomogram was externally validated using Gene Expression Omnibus (GEO) dataset. ResultsThe nomogram for predicting ALN metastasis yielded a C-index of 0.728 (95% CI: 0.698-0.758) and an AUC of 0.728 (95% CI: 0.697-0.758) in the TCGA cohort. In the independent validation cohort, the C-index and AUC of the nomogram were up to 0.825 (95% CI: 0.695-0.955) and 0.810 (95% CI: 0.666-0.953), respectively. ConclusionThis nomogram could predict the risk of axillary lymph node metastasis in breast cancer and may provide a reference for clinicians to design individualized axillary lymph node management strategies.