Development and validation of a SEER-derived prognostic nomogram for non-metastatic Asian breast cancer patients
Background Breast cancer (BC) is the most prevalent cancer among American women. Asian Americans are confronting a rapidly increasing incidence, facing unique challenges within the healthcare system that contribute to disparities in cancer outcomes. This study aimed to develop and validate a prognostic nomogram for predicting long-term survival in Asian BC patients utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Methods Asian female BC patients diagnosed between 2000 and 2021 were identified from the SEER database. Following the application of inclusion and exclusion criteria, 38,269 patients were included and randomly divided into training (70%) and validation (30%) cohorts. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors, which were incorporated into a nomogram. The model’s discriminative ability, calibration, and clinical utility were evaluated. Results Independent predictors of overall survival included age, tumor grade, marital status, T stage, N stage, subtype, radiotherapy, and chemotherapy. The nomogram demonstrated strong discriminative performance, with concordance indices of 0.794 and 0.811 in the training and validation cohorts, respectively, demonstrating better discriminative performance than the traditional tumor-node-metastasis (TNM) staging system. Calibration plots and decision curve analysis confirmed excellent calibration and clinical applicability. Conclusions This study presents a prognostic nomogram developed and validated exclusively in a large cohort of non-metastatic Asian American BC patients from the SEER database, incorporating modern molecular subtypes to improve prognostic stratification for this understudied population. By integrating readily available clinicopathological factors, the nomogram provides personalized survival forecasts, serving as a valuable tool for individualized management in this unique population. Further external validation and refinements are warranted to enhance its clinical utility.