{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:20:02Z","timestamp":1763702402407,"version":"3.45.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013794","name":"Shanxi Provincial Education Department","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Breast cancer-related arm lymphedema (BCRaL) is a prevalent and severe complication post-breast cancer treatment, especially following axillary lymph node dissection (ALND). This study aimed to develop a nomogram for BCRaL risk prediction by identifying and integrating key risk factors, including chemotherapy type (neoadjuvant vs. adjuvant), to enhance individualized patient monitoring and prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of clinical data from 535 breast cancer patients who received ALND and chemotherapy. Patients were divided into a training cohort (70%) and a validation cohort (30%). Univariate and multivariate Cox regression analyses identified independent risk factors for BCRaL, which were subsequently used to construct a nomogram. The model\u2019s performance was assessed through calibration curves, ROC curves, and clinical decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence of BCRaL in our cohort was 20.6%. Multivariate analysis identified several independent risk factors for BCRaL, including elevated body mass index (BMI), increased number of positive axillary lymph nodes, neoadjuvant chemotherapy (NAC), HER2-targeted therapy, and supraclavicular radiotherapy (SCRT). The nomogram developed based on these factors demonstrated strong predictive accuracy, with C-index values of 0.692 in the training cohort and 0.719 in the validation cohort. ROC curve analysis revealed AUC values reaching 0.760, indicating good discriminative ability. Time-dependent ROC curves further confirmed the model\u2019s consistency across different follow-up periods. DCA validated the clinical utility of the nomogram, while survival analysis clearly distinguished between high-risk and low-risk BCRaL groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study developed and internally validated a predictive model that integrates modern treatment modalities (NAC, HER2-targeted therapy, SCRT) with traditional risk factors to identify high-risk BCRaL patients undergoing ALND and chemotherapy. The model requires external validation in future studies. Consequently, the nomogram presents a potential tool for strategizing precision prevention, necessitating further evaluation before its broader adoption in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2025.1667939","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:15:00Z","timestamp":1763702100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nomogram for predicting risk of arm lymphedema following axillary lymph node dissection in breast cancer 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