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

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.