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

Authors

Yujun Tong, Tiantian Liang, Jiangping Yu, Hong Ning, Xiaohong Zhang, Zhen Zhang, Siyu Liu, Min Yang

Published in

Frontiers in pharmacology. Volume 17. Pages 1794696. Epub Sep 08, 2026.

Abstract

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.
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.
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.
Mianyang Central Hospital, a tertiary referral center in China.
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).
Occurrence of CIPN ≥ Grade 3 according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
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.
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.

PMID:
42774478
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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