Nomogram for predicting preoperative axillary lymph node status in male breast carcinoma: SEER population-based study

Abstract

Abstract Background: Sentinel lymph node (SLN) has been recommended as a replacement for axillary lymph node dissection (ALND) in male breast carcinoma (MBC) with clinical axillary lymph node-negative as in women. However, the morbidity after SLN may also have short-term or long-term complications. It is imperative to develop a model to evaluate the risk of lymph node metastasis to avoid unnecessary operations. Patients and Methods: A retrospective review of the clinical and pathology records were performed in patients diagnosed with MBC between 2010 and 2018 from Surveillance, Epidemiology, and End Results (SEER) database. The cohort was divided into training and validation cohorts. A logistic regression model was used to construct the nomogram in the training cohort and then verified in the validation cohort.ROC curve, C-index, and calibration were used to assess the predictive ability of the nomogram. Results: Overall, 2,610 patients diagnosed with MBC were enrolled, of which 1,740 were in the training cohort and 870 were in the validation cohort. Logistic regression analysis indicated ,age at diagnosis, tumor location, tumor stage, pathological type, and histologic grade were significantly related to axillary lymph node metastasis(ALNM). The AUC of the nomogram was 0.846 (95% CI, 0.825 -0.867) and C-index was 0.848 (95%CI, 0.807-0.889), demonstrating a good prediction performance. The calibration curve for the nomogram was plotted and the slope was close to 1. The performance of the nomogram was further validated in the validation cohort, with an AUC of 0.848 (95% CI 0.819 - 0.877). Conclusion: We successfully established a nomogram to predict LANM, especially for those who were of advanced age at diagnosis,had small tumor size, low malignancy, and clinical axillary lymph node-negative to avoid unnecessary axillary operation —thus improving the quality of life of the patients without adverse effect on their survival rates.