{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:48:39Z","timestamp":1791319719817,"version":"4.3.1"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Secondary lymphedema is a common, harmful side effect of breast cancer treatment. Robust risk models that are externally validated are needed to facilitate clinical translation. A published risk model used 5 accessible clinical factors to predict the development of breast cancer\u2013related lymphedema; this model included a patient\u2019s mammographic breast density as a novel predictive factor.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the external validity of a previously reported 5-factor model by applying it to an independent cohort of patients with breast cancer.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prognostic study collected data on a longitudinal cohort of patients with predominantly early-stage breast cancer treated with curative intent at the Princess Margaret Cancer Centre in Toronto, Canada between February 1, 2010, and July 31, 2014, with a median (IQR) follow-up of 4.3 (2.4-7.6) years. The 5 factors (age, body mass index, breast density, nodal burden, and use of axillary lymph node dissection [ALND]) were used as input into the established regression-based model. The analysis was performed from July 2 through August 29, 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Lymphedema after breast cancer treatment.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Lymphedema-free survival (LFS) was analyzed using Kaplan-Meier analysis, and sensitivity, specificity, and accuracy performance metrics of predicting breast cancer\u2013related lymphedema were calculated.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 101 female patients (median [IQR] age, 54.8 [48.8-62.3] years) were included in the analysis. These patients had localized or locoregional breast cancer treated with primary lumpectomy (90 [89%]) or mastectomy (11 [11%]); 75 (74%) had no axillary biopsy or sentinel lymph node biopsy; 26 (26%) had undergone ALND; and 38 (38%) had received chemotherapy, 101 (100%) received radiotherapy, and 64 (63%) received hormone therapy. Kaplan-Meier analysis showed a 2-year LFS of 97.5% (95% CI, 94.0%-100.0%) vs 65.0% (95% CI, 47.1%-89.7%) for the low- vs high-risk groups as defined by the 5-factor model (P<\/jats:italic>\u2009&amp;lt;\u2009.001). The model sensitivity was 0.83 (95% CI, 0.52-0.98), specificity was 0.89 (95% CI, 0.80-0.94), and accuracy was 0.88 (95% CI, 0.80-0.94) for predicting breast cancer\u2013related lymphedema.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings validate the performance of a 5-factor risk model for its prediction of 2-year LFS. Future clinical translation of this model can help with identifying patients at the highest risk of breast cancer\u2013related lymphedema to facilitate closer surveillance and\/or preventive management to improve health outcomes and quality of life.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.55383","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T16:13:14Z","timestamp":1737475994000},"page":"e2455383","source":"Crossref","is-referenced-by-count":13,"title":["External Validation of a 5-Factor Risk Model for Breast Cancer\u2013Related Lymphedema"],"prefix":"10.1001","volume":"8","author":[{"given":"Cherie","family":"Lin","sequence":"first","affiliation":[{"name":"Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Su","sequence":"additional","affiliation":[{"name":"Biostatistics Division, Princess Margaret Cancer Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison J.","family":"Wu","sequence":"additional","affiliation":[{"name":"MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison-Shira","family":"Hossack","sequence":"additional","affiliation":[{"name":"Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Shi","sequence":"additional","affiliation":[{"name":"Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"Biostatistics Division, Princess Margaret Cancer Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei-Fei","family":"Liu","sequence":"additional","affiliation":[{"name":"Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada"},{"name":"Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer Y. 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