Clinical Research Papers:

A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study

Jian Zhang, Xiao Li, Rong Huang, Wei-Liang Feng, Ya-Nan Kong, Feng Xu, Lin Zhao, Qing-Kun Song, Jing Li, Bao-Ning Zhang, Jin-Hu Fan, You-Lin Qiao, Xiao-Ming Xie, Shan Zheng, Jian-Jun He and Ke Wang _

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Oncotarget. 2017; 8:35311-35325. https://doi.org/10.18632/oncotarget.13330

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Jian Zhang1, Xiao Li1, Rong Huang2,3, Wei-Liang Feng4, Ya-Nan Kong5, Feng Xu6, Lin Zhao7, Qing-Kun Song2, Jing Li2, Bao-Ning Zhang8, Jin-Hu Fan2, You-Lin Qiao2, Xiao-Ming Xie5, Shan Zheng9, Jian-Jun He1 and Ke Wang1

1 Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China

2 Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China

3 Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China

4 Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R. China

5 Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China

6 Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha, P.R. China

7 Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, P.R. China

8 Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China

9 Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China

Correspondence to:

Ke Wang, email:

Jian-Jun He, email:

Keywords: breast cancer, axillary lymph node metastasis, prediction model, nomogram

Received: June 21, 2016 Accepted: October 26, 2016 Published: November 12, 2016


Axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) alone may lead to postoperative complications. Among patients with positive ALN in the preoperative examination, approximately 40% patients do not have SLN metastasis. Herein, we aimed to develop a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. We retrospectively analyzed the clinicopathological features of 4211 female patients with breast cancer who were diagnosed in seven breast cancer centers representing entire China, over 10 years (1999-2008). The patients were randomly categorized into a training cohort or validation cohort (3:1 ratio). Multivariate logistic regression analysis was performed for 1869 patients with complete information on the study variables. Age at diagnosis, tumor size, tumor quadrant, clinical nodal status, local invasion status, pathological type, and molecular subtypes were the independent predictors of ALN metastasis. The nomogram was then developed using the seven variables. Further, it was subsequently validated in 642 patients with complete data on variables in the validation cohort. Coefficient of determination (R²) and the area under the receiver-operating characteristic (ROC) curve (AUC) were calculated to be 0.979 and 0.7007, showing good calibration and discrimination of the model, respectively. The false-negative rates of the nomogram were 0 and 6.9% for the predicted risk cut-off values of 14.03% and 20%, respectively. Therefore, when the predicted risk is less than 20%, SLNB may be avoided. After further validation in various patient populations, this model may support increasingly limited axillary surgery in breast cancer.

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