A nomogram prediction for the survival of patients with triple negative breast cancer

Triple negative breast cancer (TNBC) is a subtype of breast cancer with poor prognosis. In this study, we aimed to conduct a nomogram to predict the survival of individual with TNBC by incorporating significant clinical and laboratory parameters. 404 TNBC patients from the Affiliated Union Hospital of Fujian Medical University between 2006 and 2012 were selected in the training cohort. Cox univariate and multivariate regression analyses were adopted to identify independent prognostic factors. The predictive accuracy and discriminative ability of this nomogram were evaluated by concordance index (C-index) and calibration curve. The accuracy of this nomogram was also compared with the 8(th) AJCC TNM staging system. An external validation cohort was further performed in an independent cohort of 200 patients between 2012 and 2014. Seven independent prognostic factors, including family history of breast cancer, tumor location, number of positive lymph nodes, histological grade, serum CEA, CA125 and CA153 were identified as independent prognostic factors. A nomogram incorporating these prognostic factors was subsequently conducted and the calibration plot on the probability for 3 or 5 years overall survival (OS) showed an optimal agreement between the nomogram prediction and actual observations. In addition, the C-index of this nomogram was higher than that of TNM staging system in both training and validation cohort (training cohort, 0.76 vs. 0.66, p<0.001 and validation cohort, 0.72 vs. 0.64, p=0.002, respectively). This proposed nomogram could provide more accurate individual prediction for the prognosis of the patients with TNBC and was able to help physicians to identify subgroups of patients at different risk and to decide who need intensive follow-up or additional treatment.