Development and validation of a nomogram to predict failure rate in immediate implant-based breast reconstruction
Objective To evaluate the risk factors for immediate implant-based breast reconstruction(IBR)failure,and to construct a nomogram model and validate it.Methods A total of 241 patients who underwent immediate IBR surgery in Zhejiang Cancer Hospital from January 2016 to December 2020 were retrospectively analyzed and randomly divided into a training cohort(169 cases)and a validation cohort(72 cases)by 7:3.The training cohort was divided into reconstruction failure(RF)group(10 cases)and non-RF group(159 cases)based on whether RF occurred.Clinical data that might affect RF in immediate IBR surgery were collected.Multivariate logistic regression was used to analyze independent risk factors affecting RF to establish a nomogram and the ROC curves were drawn to evaluate the efficiency of the model prediction.Calibration curves were also drawn to assess the consistency of RF after immediate IBR surgery.Results Multivariate logistic regression analysis showed that high BMI,implant volume>86.30%,and adjuvant chemotherapy(ACT)were independent risk factors for RF in immediate IBR surgery(all P<0.05).A nomogram model was constructed based on five variables:BMI,lymph node surgery type,implant volume,mesh application and ACT.The AUC of the model in predicting the RF of immediate IBR surgery was 0.920 in training cohort and was 0.930 in validation cohort,the Brier score was 0.040 respectively.The calibration curve showed good consistency between the actual observation and the model prediction.Conclusion The nomogram established shows good performance in predicting the risk of RF in immediate IBR surgery and is easy to use,which can guide the early intervention of RF.
Breast implantBreast reconstructionReconstruction failureNomogram