Abstract
PURPOSE: Overall survival (OS) in postoperative breast cancer patients is influenced by various clinicopathological features. Current prognostic methods, such as the 7th edition of AJCC staging, have limitations. This study aims to construct and validate a comprehensive nomogram integrating multiple clinicopathological features to predict OS more accurately in breast cancer patients. METHODS: We identified 60,445 .female patients who underwent breast cancer surgery between January 1, 2011, and December 31, 2015, from the Surveillance, Epidemiology, and End Results (SEER) database, randomly divided into training and internal validation cohorts. Additionally, data from 332 breast cancer surgery patients from four hospitals in Taizhou, Zhejiang Province, were included as an external validation cohort. Kaplan-Meier analysis assessed the impact of clinicopathological features on OS, and multivariable Cox regression identified independent prognostic factors. A nomogram based on these factors was constructed to predict 1-, 3-, and 5-year OS. Model predictive performance was evaluated using C-index, AUC, calibration curves, and decision curves during internal and external validation. RESULTS: Multivariable Cox regression analysis identified age, pathological grade, AJCC stage, ER status, PR status, and HER2 status as independent prognostic factors used in the nomogram construction. The nomogram achieved a C-index of 0.724 (95% CI, 0.716-0.732) in the training cohorts, 0.717 (95% CI, 0.705-0.729) in the internal validation cohorts, and 0.793 (95% CI, 0.724-0.862) in the external validation cohorts, indicating strong discriminative ability. Calibration curves demonstrated good agreement between predicted and observed outcomes in all validation cohorts. Decision curve analysis showed that the nomogram provided maximum net benefit across all validation cohorts. CONCLUSION: The nomogram developed in this study integrates multiple clinicopathological features and provides a convenient and accurate tool for predicting individualized OS in breast cancer patients. This tool can optimize treatment strategies and improve patient prognosis.