Send to

Choose Destination
Cancer Med. 2017 Nov;6(11):2586-2594. doi: 10.1002/cam4.1224. Epub 2017 Oct 4.

Development and validation of a nomogram predicting the overall survival of stage IV breast cancer patients.

Li S1,2, Zhao J1,2, Zhu L1,2,3, Su F1,2, Chen K1,2.

Author information

Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut, 06511.


This study aimed to develop a nomogram to predict the overall survival (OS) of stage IV breast cancer patients. We searched the National Cancer Database (NCDB) for stage IV breast cancer patients diagnosed between 2010 and 2013. Predictors of OS were identified and a nomogram was developed and validated using concordance index (C-index), calibration plots, and risk group stratifications. A total of 7199 patients from the NCDB were included in the study. With a median follow-up of 25.7 months, the 1-year and 3-year OS rates were 80.6% and 52.5%, respectively. Race, age, comorbidity status, T-stage, grade, ER/PR/Her2 status, the presence of lung/liver/brain metastasis, surgery, radiotherapy, and chemotherapy were significantly associated with OS. The developed nomogram had a C-index of 0.722 (95% CI 0.710-0.734) and 0.725 (95% CI 0.713-0.736) in the training and the validation cohorts, respectively. The predicted survival using the nomogram is well correlated with actual OS. The nomogram was able to stratify patients into different risk groups, among which the survival benefit of local therapy varied. We developed a nomogram to predict the overall survival of stage IV breast cancer patients. Prospectively designed studies with international collaborations are needed to further validate our nomogram.


NCDB ; Breast cancer; nomogram; overall survival; prediction; prognosis; stage IV

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center