Figure 1: Flowchart
FIGURE 1
| Variables | Total (n = 152) | Training cohort (n = 122) | Validation cohort (n = 30) | ||||||||||
| ULL | SJD | ULL | SJD | ||||||||||
| Absence (n = 66) | Presence (n = 56) | P | Absence (n = 64) | Presence (n = 58) | P | Absence (n = 19) | Presence (n = 11) | P | Absence (n = 17) | Presence (n = 13) | P | ||
| Stage, n (%) | |||||||||||||
| stage I | 29 (19) | 19 (29) | 7 (12) | 0.074 | 19 (30) | 7 (12) | 0.032 | 2 (11) | 1 (9) | 0.603 | 2(12) | 1(8) | 0.387 |
| stage Ⅱ | 72 (47) | 28 (42) | 26 (46) | 28 (44) | 26 (45) | 12 (63) | 6 (55) | 11(65) | 7(54) | ||||
| stageIII | 51 (34) | 19 (29) | 23 (41) | 17 (27) | 25 (43) | 5 (26) | 4 (36) | 4(23) | 5(38) | ||||
| Surgery, n (%) | |||||||||||||
| Breast surgery | |||||||||||||
| BCS | 80 (53) | 47 (71) | 13 (23) | < 0.001 | 47 (73) | 13 (22) | < 0.001 | 15 (79) | 5 (46) | 0.108 | 12(71) | 8(62) | 0.608 |
| MRM | 72 (47) | 19 (29) | 43 (77) | 17 (27) | 45 (78) | 4 (21) | 6 (54) | 5(29) | 5(38) | ||||
| ALND | |||||||||||||
| 0 | 53 (35) | 39 (59) | 6 (11) | < 0.001 | 39 (61) | 6 (10) | < 0.001 | 5 (26) | 3 (27) | 0.955 | 7(41) | 1(8) | 0.043 |
| 1 | 99 (65) | 27 (41) | 50 (89) | 25 (39) | 52 (90) | 14 (74) | 8 (73) | 10(59) | 12(92) | ||||
| Pathology factor | |||||||||||||
| PLN, Median (Q1, Q3) | 1 (0, 3) | 0 (0, 2.75) | 2 (0.75, 4) | 0.002 | 0 (0, 1.25) | 2 (1, 4) | < 0.001 | 0(1,3) | 2(0,4) | 0.793 | 1(0,3) | 2(1.5,4) | 0.251 |
| TLN, Median (Q1, Q3) | 15 (4.25, 22) | 5 (3, 15) | 17 (13, 21.25) | < 0.001 | 5 (3, 14.25) | 17 (13.25, 21.75) | < 0.001 | 22(7,24) | 27(14,31) | 0.211 | 20(4,23.5) | 25（22,30.5） | 0.008 |
| Radiation | |||||||||||||
| Radiation field | |||||||||||||
| CW, n (%) | |||||||||||||
| 0 | 68 (45) | 40 (61) | 7 (12) | < 0.001 | 40 (62) | 7 (12) | < 0.001 | 15 (79) | 6 (55) | 0.167 | 12(71) | 9(69) | 0.937 |
| 1 | 84 (55) | 26 (39) | 49 (88) | 24 (38) | 51 (88) | 4 (21) | 5 (45) | 5(29) | 4(31) | ||||
| SI_region, n (%) | |||||||||||||
| 0 | 61 (40) | 40 (61) | 14 (25) | < 0.001 | 40 (62) | 14 (24) | < 0.001 | 5 (26) | 2 (18) | 0.618 | 7(41) | 0(0) | 0.009 |
| 1 | 91 (60) | 26 (39) | 42 (75) | 24 (38) | 44 (76) | 14 (74) | 9 (82) | 10(59) | 13(100) | ||||
| IM_region, n (%) | |||||||||||||
| 0 | 103(68) | 53 (80) | 36 (64) | 0.075 | 52 (81) | 37 (64) | 0.05 | 10 (53) | 4 (36) | 0.397 | 10(59) | 4(31) | 0.133 |
| 1 | 49 (32) | 13 (20) | 20 (36) | 12 (19) | 21 (36) | 9 (47) | 7 (64) | 7(41) | 9(69) | ||||
| Dosimetry factor | |||||||||||||
| Dose, Median (Q1, Q3) | 58.40 (50.00, 58.40) |
58.40 (50.00, 59.12) |
53.50 (50.00, 59.36) |
0.624 | 58.40 (50.00, 59.36) |
51.75 (50.00, 59.36) |
0.42 | 58.4 | 58.4 | 0.605 | 58.4 | 58.4 | 0.037 |
| (58.40, 58.40) | （50.00, 58.40） | (58.40, 58.40) | （50.00, 58.40） | ||||||||||
| I_Dmin, x±s | 2568.92 ± 1477.17 |
1932.52 ± 977.59 |
2804.24 ± 1300.24 |
< 0.001 | 1893.8 ± 965.29 |
2816.91 ± 1280.74 |
< 0.001 | 3195.37 ± 2103.64 |
4107.25 ± 1772.29 |
0.033 | 2512.28 ± 2172.36 |
4860.23 ± 248.41 |
0.001 |
| I_Dmax, Median (Q1, Q3) | 5326.90 (5047.08, 5634.9) |
5170 (5034.32, 5442.4) |
5467.25 (5109.6, 5902.52) |
0.008 | 5168.5 (5033.42, 5433.4) |
5461.75 (5113.1, 5889.22) |
0.006 | 5402.60 (5010.40,5454.80) |
5394.50 (5294.40,5405.80) |
0.813 | 5338.50 (4851.10,5471.60) |
5405.40 (5363.35,5434.25) |
0.25 |
| I_Dmean, Median (Q1, Q3) | 4282.05 (3480.35, 4946.5) |
3983.95 (3453.52, 4391.1) |
4386.45 (3520.85, 4870.18) |
0.04 | 3976.95 (3444.7, 4376.4) |
4424.7 (3549.6, 4876.52) |
0.017 | 5174.40 (1551.40,5233.20) |
5181.20 (5135.90,5252.80) |
0.237 | 5134.70 (1369.95,5233.45) |
5191.40 (5174.70,5248.00) |
0.063 |
| I_D/V, Median (Q1,Q3) | 152.95 (74.80, 259.37) |
102.55 (72.3, 230.03) |
143.55 (71.85, 233.25) |
0.6 | 102.55 (71.6, 225.47) |
143.55 (75.62, 237.65) |
0.535 | 237.22 (136.94,261.81) |
263.69 (162.58,418.36) |
0.272 | 223.58 (95.54,307.59) |
241.15 (203.75,278.21) |
0.305 |
| Ⅱ_Dmin, Median (Q1, Q3) | 3162.05 (1056.25, 4240.1) |
2924.2 (1056.25, 3797.1) |
2911.75 (900.7, 4239.92) |
0.646 | 2887.2 (1038.6, 3723.73) |
3106.1 (998.77, 4190.25) |
0.45 | 3723.60 (602.70,4286.50) |
4281.30 (2264.30,4755.60) |
0.175 | 3172.30 (418.70,4019.00) |
4286.50 (3842.90,4462.10) |
0.016 |
| Ⅱ_Dmax, Median (Q1, Q3) | 5244.20 (4671.25, 5506.3) |
5051.8 (4630.42, 5441.0) |
5316.3 (4264.65, 5746.5) |
0.311 | 5038.85 (4619.1, 5419.48) |
5371.8 (4310.5, 5736.32) |
0.205 | 5341.90 (5258.50,5486.30) |
5378.90 (5304.90,5433.10) |
0.763 | 5341.90 (5142.25,5484.90) |
5378.90 (5323.25,5426.35) |
0.403 |
| Ⅱ_Dmean, Median (Q1, Q3) | 4462.10 (3048.95, 5098.7) |
4083.55 (2724.55, 5067.1) |
4424.95 (3021.45, 5135.15) |
0.343 | 4025.35 (2676.43, 5049.5) |
4450.95 (3099.6, 5137.12) |
0.225 | 4883.90 (3187.60,5100.60) |
5052.70 (4901.10,5180.40) |
0.107 | 4677.20 (2741.10,5023.75) |
5093.10 (5014.70,5135.90) |
0.009 |
| Ⅱ_D/V, Median (Q1,Q3) | 261.15 (150.30, 417.70) |
262.2 (144.27, 401.9) |
323.25 (186.02, 469.45) |
0.169 | 262.2 (141.98, 416.05) |
309.85 (185.68, 466.57) |
0.214 | 186.55 (127.36,242.62) |
239.94 (132.92,319.13) |
0.401 | 157.29 (123.41,218.56) |
243.38 (167.06,287.09) |
0.025 |
| Ⅲ_Dmin, Median (Q1, Q3) | 2717.35 (1325.55, 3977.0) |
2800.7 (1283.2, 4156.8) |
2908.7 (1320, 4145.82) |
0.742 | 2793.75 (1245.7, 4090.28) |
3034.75 (1422.0, 4224.48) |
0.453 | 2197.60 (1322.40,2709.90) |
2864.00 (1935.30,4004.50) |
0.061 | (1369.95,5233.45) | 3042.70 (2350.15,3265.10) |
0.009 |
| Ⅲ_Dmax, Median (Q1, Q3) | 4769.85 (3227.15, 5389.7) |
4823.1 (3612.62, 5467.6) |
3751.55 (2280.33, 5189.9) |
0.03 | 4769.85 (3489.3, 5422.52) |
3935.55 (2310.1, 5248.02) |
0.1 | 5113.00 (4807.10,5387.20) |
5179.90 (4907.90,5390.60) |
0.78 | 1883.90 (594.05,2509.00) |
5213.60 (5067.90,5339.95) |
0.325 |
| Ⅲ_Dmean, Median (Q1, Q3) | 3915.60 (2222.58, 5041.4) |
4091.95 (1812.28, 5171.9) |
3373.65 (2217.4, 5018.25) |
0.581 | 3600.9 (1736.5, 5169.35) |
3539.5 (2260.0, 5039.85) |
0.92 | 4054.60 (3711.80,4257.40) |
4183.20 (3975.50,4705.50) |
0.312 | 5030.30 (4702.50,5391.40) |
4225.80 (4059.05,4515.10) |
0.047 |
| Ⅲ_D/V, Median (Q1,Q3) | 213.40 (119.91, 378.10) |
241 (102.38, 376.8) |
231.7 (107.05, 444.7) |
0.706 | 241 (95.17, 388.5) |
231.7 (110.55, 442.72) |
0.714 | 188.15 (129.44,211.59) |
190.49 (123.35,359.89) |
0.451 | 137.09 (121.52,228.35) |
199.42 (179.76,345.11) |
0.069 |
| ACDmin, Median (Q1, Q3) | 3364.00 (2304.33, 4474.2) |
3384.4 (2342.73, 4487.1) |
4160.65 (3175.52, 4662.98) |
0.02 | 3364 (2319.85, 4469.3) |
4160.65 (3221.6, 4667.32) |
0.01 | 1867.40 (326.80,2433.90) |
2664.40 (752.80,3789.50) |
0.061 | 3975.50 (2918.50,4237.80) |
2664.40 (2084.60,3048.60) |
0.008 |
| ACDmax, x±s | 5441.94 ± 328.74 |
5406.03 ± 302.4 |
5502.45 ± 405.17 |
0.145 | 5400.82 ± 305.59 |
5504.88 ± 398.28 |
0.111 | 5407.92 ± 163.97 |
5408.06 ± 231.78 |
0.88 | 5384.74 ± 247.84 |
5438.35 ± 37.91 |
0.49 |
| ACDmean, Median (Q1,Q3) | 4806.05 (4087.70, 5084.4) |
4857 (4039.2, 5121.4) |
4818.7 (4168.7, 5096.33) |
0.961 | 4824.75 (4012.6, 5110.95) |
4837.9 (4205.9, 5097.38) |
0.703 | 4676.30 (2930.40,4878.80) |
4816.50 (4700.00,4993.30) |
0.149 | 4463.90 (2307.70,4815.70) |
4848.20 (4743.95,4957.90) |
0.016 |
| ACD/V, Median (Q1,Q3) | 356.35 (58.96, 914.28) |
563.75 (263.17, 940.08) |
459.8 (97.5, 1005.02) |
0.522 | 527.3 (240.82, 935.22) |
486.5 (104.58, 1001.78) |
0.684 | 48.94 (32.18,59.1) |
48.82 (30.86,92.07) |
0.533 | 39.65 (28.94,59.38) |
53.33 (42.69,74.84 |
0.09 |
Table 1: Comparison of clinical factors between the training cohort and validation cohort.
| Characteristics | Univariate analysis | Multivariate analysis | ||||
| OR | CI | P | OR | CI | P | |
| Stage | 3.29 | 1.14-9.47 | 0.028 | 1.79 | 0.08-41.46 | 0.716 |
| ALND | 12.04 | 4.52-32.03 | <0.001< /td> | 151.44 | 4.22-4544 | <0.001< /td> |
| MRM | 8.18 | 3.61-18.54 | <0.001< /td> | 67.91 | 2.44-1892.49 | 0.013 |
| PLN | 1.03 | 0.96-1.1 | 0.441 | NA | NA | NA |
| TLN | 1.11 | 1.06-1.16 | <0.001< /td> | 1.05 | 0.95-1.17 | 0.344 |
| CW | 10.77 | 4.24-27.38 | <0.001< /td> | 5.32 | 0.27-106.51 | 0.275 |
| IM_region | 2.26 | 1-5.12 | 0.05 | NA | NA | NA |
| SI_region | 4.62 | 2.11-10.08 | <0.001< /td> | 0.05 | 0-1.14 | 0.06 |
| Dose | 0.96 | 0.89-1.03 | 0.273 | NA | NA | NA |
| I_Dmin | 1 | 0.98-0.99 | <0.001< /td> | 2.20 | 1.11-4.38 | 0.026 |
| I_Dmax | 1 | 0.98-0.99 | 0.005 | 1.12 | 1.05-1.20 | <0.001< /td> |
| I_Dmean | 1 | 0.99-1.01 | 0.055 | NA | NA | NA |
| I_D/V | 1 | 0.93-1.02 | 0.622 | NA | NA | NA |
| II_Dmin | 1 | 0.66-2.62 | 0.666 | NA | NA | NA |
| II_Dmax | 1 | 0.82-5.6 | 0.721 | NA | NA | NA |
| II_Dmean | 1 | 0.43-2.81 | 0.335 | NA | NA | NA |
| II_D/V | 1 | 0.98-1.02 | 0.157 | NA | NA | NA |
| III_Dmin | 1 | 0.55-5.2 | 0.801 | NA | NA | NA |
| III_Dmax | 1 | 0.98-0.99 | 0.024 | NA | NA | NA |
| III_Dmean | 1 | 0.71-4.36 | 0.665 | NA | NA | NA |
| III_D/V | 1 | 0.68-3.23 | 0.682 | NA | NA | NA |
| ACDmin | 1 | 0.97-0.99 | 0.035 | NA | NA | NA |
| ACDmax | 1 | 0.99-1.02 | 0.136 | NA | NA | NA |
| ACDmean | 1 | 0.93-1.06 | 0.758 | NA | NA | NA |
| ACD/V | 1 | 0.92-1.03 | 0.568 | NA | NA | NA |
Table 2: The univariate and multivariate logistic regression of ULL
| Characteristics | Univariate analysis | Multivariate analysis | ||||
| OR | CI | P | OR | CI | P | |
| Stage | 3.99 | 1.38-11.56 | 0.011 | 0.25 | 0.01-4.11 | 0.33 |
| ALND | 13.52 | 5.06-36.13 | <0.001< /td> | 181.53 | 5.79-287.52 | 0.003 |
| MRM | 9.57 | 4.17-21.94 | <0.001< /td> | 19.88 | 1.49-265.28 | 0.024 |
| PLN | 1.08 | 0.99-1.16 | 0.07 | NA | NA | NA |
| TLN | 1.12 | 1.07-1.18 | <0.001< /td> | 1.06 | 0.95-1.19 | 0.307 |
| CW | 12.14 | 4.75-31.03 | <0.001< /td> | 2.65 | 0.17-41.79 | 0.489 |
| IM_region | 2.46 | 1.08-5.61 | 0.033 | 5.38 | 0.8-36 | 0.083 |
| SI_region | 5.24 | 2.39-11.5 | <0.001< /td> | 0.28 | 0.04-2.24 | 0.231 |
| Dose | 0.95 | 0.88-1.02 | 0.153 | NA | NA | NA |
| I_Dmin | 1 | 0.98-0.99 | <0.001< /td> | 1.13 | 1.07-1.20 | <0.001< /td> |
| I_Dmax | 1 | 0.98-0.99 | 0.005 | 2.61 | 1.46-4.68 | 0.001 |
| I_Dmean | 1 | 0.96-0.98 | 0.025 | NA | NA | NA |
| I_D/V | 1 | 0.43-2.32 | 0.595 | NA | NA | NA |
| II_Dmin | 1 | 0.72-3.86 | 0.469 | NA | NA | NA |
| II_Dmax | 1 | 0.76-4.13 | 0.544 | NA | NA | NA |
| II_Dmean | 1 | 0.83-2.69 | 0.212 | NA | NA | NA |
| II_D/V | 1 | 0.42-2.2 | 0.206 | NA | NA | NA |
| III_Dmin | 1 | 0.51-2.95 | 0.516 | NA | NA | NA |
| III_Dmax | 1 | 0.89-1.71 | 0.059 | NA | NA | NA |
| III_Dmean | 1 | 0.82-6.23 | 0.972 | NA | NA | NA |
| III_D/V | 1 | 0.62-5.36 | 0.735 | NA | NA | NA |
| ACDmin | 1 | 0.88-0.93 | 0.019 | NA | NA | NA |
| ACDmax | 1 | 0.61-8.64 | 0.108 | NA | NA | NA |
| ACDmean | 1 | 0.83-6.82 | 0.547 | NA | NA | NA |
| ACD/V | 1 | 0.53-10.12 | 0.735 | NA | NA | NA |
Table 3: The univariate and multivariate logistic regression of SJD
Figure 1: Flowchart
Figure 2: Nomogram of ULL
Figure 3: Calibration curves of (A) training set and (B) validation set in the ULL normogram. ROC curves and the area under the curve of (C) Training set and (D) validation set in the ULL normogram. DCA curves of (E) the training set and (F) the validation set in the ULL normogram.
Figure 4: Nomogram of SJD
Figure 5: Calibration curves of (A) training set and (B) validation set in the ULL normogram. ROC curves and the area under the curve of (C) Training set and (D) validation set in the ULL normogram. DCA curves of (E) the training set and (F) the validation set in the ULL normogram.
Tables at a glance
Figures at a glance