A real-world nomogram integrating predictive markers for disease-free survival in postmenopausal triple-negative breast cancer receiving anthracycline/taxane-based chemotherapy
5 affiliations
- 1Department of Geriatric Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
- 2Fujian Provincial Center for Geriatrics, Fujian Provincial Hospital, Fuzhou, Fujian, China
- 3Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- 4Department of Thyroid and Breast Surgery, Comprehensive Breast Health Center, The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People’s Hospital, Lishui, Zhejiang, China
- 5Department of Breast Surgery, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Fuzhou, Fujian, China
Abstract
Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with poor prognosis, especially in postmenopausal women who are routinely treated with anthracycline/taxane-based chemotherapy. However, wide inter-individual variation in disease-free survival (DFS) underscores an urgent need for reliable predictive markers and practical prognostic tools. We aimed to develop and validate a real-world nomogram that integrates clinically accessible predictive markers for individualised DFS prediction in this specific population.
Methods: In this two-centre real-world study, we enrolled 479 postmenopausal TNBC patients who received initial adjuvant anthracycline/taxane-based chemotherapy (sequential or concurrent). Patients were randomly assigned 7:3 to a training cohort (n=335) and a validation cohort (n=144). We used univariate and multivariate Cox regression with stepwise bidirectional selection to identify independent predictors, which were then incorporated into a nomogram. Model performance was assessed using Harrell’s C-index, time-dependent receiver operating characteristic curves, and calibration plots.
Results: Baseline characteristics did not differ significantly between the two cohorts (all P>0.05). Multivariate Cox analysis identified four independent predictors: postoperative pathological T stage (T2+T3 vs T1: hazard ratio [HR]=2.607, 95% CI 1.347-5.047, P = 0.004); N stage (N2 vs N0: HR = 4.077, 2.049-8.112, P<0.001; N3 vs N0: HR = 4.479, 2.561-7.835, P<0.001); high stromal tumour-infiltrating lymphocyte (sTIL) expression (vs low: HR = 0.025, 0.008-0.081, P<0.001); and Ki67 >20% (vs ≤20%: HR = 2.060, 1.082-3.919, P = 0.028). The nomogram achieved excellent discrimination: training cohort C-index=0.899; validation cohort C-index=0.861. Time-dependent AUCs for 1-, 3-, and 5-year DFS were 0.915, 0.945, and 0.959 in the training cohort, and 0.895, 0.943, and 0.900 in the validation cohort, respectively. Calibration curves showed good agreement between predicted and observed outcomes.
Conclusion: We developed and validated a real-world nomogram integrating four readily available predictive markers-T stage, N stage, sTIL, and Ki67-that accurately predicts 1-, 3-, and 5-year DFS in postmenopausal TNBC patients receiving standard anthracycline/taxane chemotherapy. This practical tool supports personalised risk stratification and clinical decision-making, directly addressing the need for predictive markers in advancing breast cancer chemotherapy.
Related
- Prospective External Validation of the HFA-ICOS Baseline Cardiovascular Risk Classification in Women with Breast Cancer Receiving Anthracycline-Containing Therapy in a Central Asian Cohort
- Early Lymphocyte Dynamics and Subsequent Cancer Therapy-Related Cardiac Dysfunction in Patients Receiving Anthracycline Therapy
- Incident Atrial Fibrillation Following Anthracycline-Based Adjuvant Chemotherapy in Women with Breast Cancer: A Single-Centre Retrospective Cohort Study.
- Cardiotoxicity of Immune Checkpoint Inhibitors with Anthracycline Chemotherapy in Triple-Negative Breast Cancer.
- Adjuvant Docetaxel–Cyclophosphamide Versus Anthracycline–Taxane Chemotherapy in Stage I–III HR-Positive/HER2-Negative Breast Cancer: A Real-World Propensity Score Overlap-Weighted Cohort Study
BibTeX
@article{lin2026realworld,
title = {{A real-world nomogram integrating predictive markers for disease-free survival in postmenopausal triple-negative breast cancer receiving anthracycline/taxane-based chemotherapy}},
author = {Yan Lin and Shao-hong Yu and Chai-Ming Zeng and Shuang-long Cai and Lei Han},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1904801},
url = {https://doi.org/10.3389/fonc.2026.1904801},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A real-world nomogram integrating predictive markers for disease-free survival in postmenopausal triple-negative breast cancer receiving anthracycline/taxane-based chemotherapy
AU - Yan Lin
AU - Shao-hong Yu
AU - Chai-Ming Zeng
AU - Shuang-long Cai
AU - Lei Han
PY - 2026
DA - 2026/10/12
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1904801
UR - https://doi.org/10.3389/fonc.2026.1904801
AB - Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with poor prognosis, especially in postmenopausal women who are routinely treated with anthracycline/taxane-based chemotherapy. However, wide inter-individual variation in disease-free survival (DFS) underscores an urgent need for reliable predictive markers and practical prognostic tools. We aimed to develop and validate a real-world nomogram that integrates clinically accessible predictive markers for individualised DFS prediction in this specific population. Methods: In this two-centre real-world study, we enrolled 479 postmenopausal TNBC patients who received initial adjuvant anthracycline/taxane-based chemotherapy (sequential or concurrent). Patients were randomly assigned 7:3 to a training cohort (n=335) and a validation cohort (n=144). We used univariate and multivariate Cox regression with stepwise bidirectional selection to identify independent predictors, which were then incorporated into a nomogram. Model performance was assessed using Harrell’s C-index, time-dependent receiver operating characteristic curves, and calibration plots. Results: Baseline characteristics did not differ significantly between the two cohorts (all P>0.05). Multivariate Cox analysis identified four independent predictors: postoperative pathological T stage (T2+T3 vs T1: hazard ratio [HR]=2.607, 95% CI 1.347-5.047, P = 0.004); N stage (N2 vs N0: HR = 4.077, 2.049-8.112, P<0.001; N3 vs N0: HR = 4.479, 2.561-7.835, P<0.001); high stromal tumour-infiltrating lymphocyte (sTIL) expression (vs low: HR = 0.025, 0.008-0.081, P<0.001); and Ki67 >20% (vs ≤20%: HR = 2.060, 1.082-3.919, P = 0.028). The nomogram achieved excellent discrimination: training cohort C-index=0.899; validation cohort C-index=0.861. Time-dependent AUCs for 1-, 3-, and 5-year DFS were 0.915, 0.945, and 0.959 in the training cohort, and 0.895, 0.943, and 0.900 in the validation cohort, respectively. Calibration curves showed good agreement between predicted and observed outcomes. Conclusion: We developed and validated a real-world nomogram integrating four readily available predictive markers-T stage, N stage, sTIL, and Ki67-that accurately predicts 1-, 3-, and 5-year DFS in postmenopausal TNBC patients receiving standard anthracycline/taxane chemotherapy. This practical tool supports personalised risk stratification and clinical decision-making, directly addressing the need for predictive markers in advancing breast cancer chemotherapy.
SN - 2234-943X
ER -