A Nomogram Based on Radiomics with Mammography Texture Analysis for the Prognostic Prediction in Patients with Triple-Negative Breast Cancer

Abstract

Objectives. To develop and validate a radiomics-based nomogram with texture features from mammography for the prognostic prediction in patients with early-stage triple-negative breast cancer (TNBC). Methods. The study included 200 consecutive patients with TNBC (training cohort: N = 133, validation cohort: N = 67). A total of 136 mammography-derived textural features were extracted, and LASSO (least absolute shrinkage and selection operator) was applied to select features for building the radiomics score (Rad-score). After univariate and multivariate logistic regression, a radiomics-based nomogram was constructed with independent prognostic factors. The discrimination and calibration power were assessed, and further the clinical applicability of the nomograms was evaluated. Results. Among the 136 mammography-derived textural features, fourteen were used to build the Rad-score after LASSO regression. A radiomics nomogram that incorporates Rad-score and pN stage was constructed. This nomogram achieved a C-index of 0.873 (95% CI: 0.758-0.989) for predicting iDFS (invasive disease-free survival), which outperformed the clinical model. Moreover, it is feasible to stratify patients into high-risk and low-risk groups based on the optimal cut-off point of Rad-score. The validations of the nomogram confirmed favorable discrimination and considerable predictive efficiency. Conclusions. The radiomics nomogram that incorporates Rad-score and pN stage exhibited favorable performance in the prediction of iDFS in patients with early-stage TNBCs.