Validation of a nomogram for predicting the risk of lymphedema following contemporary treatment for breast cancer: a large multi-institutional study (KROG 20-05)

Hwa Kyung Byun, Jae Sik Kim, Jee Suk Chang, Yeona Cho, Sung Ja Ahn, Jung Han Yoon, Haeyoung Kim, Nalee Kim, Euncheol Choi, Hyeli Park, Kyubo Kim, Shin Hyung Park, Chai Hong Rim, Hoon Sik Choi, Yoon Kyeong Oh, Ik Jae Lee, Kyung Hwan Shin, Yong Bae Kim

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Purpose: We previously constructed a nomogram for predicting the risk of arm lymphedema following contemporary breast cancer treatment. This nomogram should be validated in patients with different background characteristics before use. Therefore, we aimed to externally validate the nomogram in a large multi-institutional cohort. Methods: Overall, 8835 patients who underwent breast cancer surgery during 2007–2017 were identified. Data of variables in the nomogram and arm lymphedema were collected. The nomogram was validated externally using C-index and integrated area under the curve (iAUC) with 1000 bootstrap samples and by calibration plots. Results: Overall, 1377 patients (15.6%) developed lymphedema. The median time from surgery to lymphedema development was 11.4 months. Lymphedema rates at 2, 3, and 5 years were 11.2%, 13.1%, and 15.6%, respectively. Patients with lymphedema had significantly higher body mass index (median, 24.1 kg/m2 vs. 23.4 kg/m2) and a greater number of removed nodes (median, 17 vs. 6) and more frequently underwent taxane-based chemotherapy (85.7% vs. 41.9%), total mastectomy (73.1% vs. 52.1%), conventionally fractionated radiotherapy (71.9% vs. 54.2%), and regional nodal irradiation (70.7% vs 22.4%) than those who did not develop lymphedema (all P < 0.001). The C-index of the nomogram was 0.7887, and iAUC was 0.7628, indicating good predictive accuracy. Calibration plots confirmed that the predicted lymphedema risks were well correlated with the actual lymphedema rates. Conclusion: This nomogram, which was developed using factors related to multimodal breast cancer treatment and was validated in a large multi-institutional cohort, can well predict the risk of breast cancer-related lymphedema.

Original languageEnglish
Pages (from-to)553-561
Number of pages9
JournalBreast Cancer Research and Treatment
Issue number3
StatePublished - Apr 2022

Bibliographical note

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Breast cancer
  • Contemporary treatment
  • Lymphedema
  • Nomogram


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