Risk prediction of severe chemotherapy-induced peripheral neuropathy in breast cancer patients receiving nab-paclitaxel: a clinical nomogram.

IMPORTANCE

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and dose-limiting toxicity of nab-paclitaxel in breast cancer patients. Severe CIPN can impair quality of life, limit treatment adherence, and lacks validated prediction tools for early risk stratification.

OBJECTIVE

To identify risk factors for grade ≥3 CIPN in breast cancer patients treated with nab-paclitaxel and to develop a predictive model for individualized risk assessment.

DESIGN

Retrospective cohort study using clinical data from January 2021 to January 2025. Predictors were selected with least absolute shrinkage and selection operator (LASSO) regression and included in multivariable logistic regression. A nomogram was constructed, and model performance was evaluated using area under the curve (AUC), Hosmer-Lemeshow test, calibration curve, and decision curve analysis. Restricted cubic spline analysis examined nonlinear associations of body mass index (BMI) and total bilirubin (TBIL) with CIPN risk.

SETTING

Mianyang Central Hospital, a tertiary referral center in China.

PARTICIPANTS

A total of 403 breast cancer patients receiving nab-paclitaxel. Among them, 13.2% (53/403) developed CIPN ≥ Grade 3. Patients with severe CIPN more frequently had higher BMI, elevated TBIL, smoking or alcohol drinking, and diabetes, and lower platelet count, total protein, and hemoglobin (all P < 0.05).

MAIN OUTCOMES AND MEASURES: Occurrence of CIPN ≥ Grade 3 according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

RESULTS

LASSO identified BMI, TBIL, smoking, alcohol drinking, and diabetes as key predictors. All were confirmed as independent risk factors in multivariable analysis, with diabetes showing the strongest association (adjusted OR = 4.01). The nomogram demonstrated good discrimination (AUC = 0.78), calibration (P = 0.898), and clinical utility. Restricted cubic spline analysis showed a linear association between TBIL and CIPN risk, and significantly increased risk with BMI ≥24 kg/m2.

CONCLUSION AND RELEVANCE: Elevated BMI, smoking, Alcohol drinking, diabetes, and TBIL are independent risk factors for severe CIPN in patients with breast cancer treated with nab-paclitaxel. The proposed nomogram may support early identification of high-risk patients and guide individualized prevention and management strategies.