摘要
目的探讨腋窝前哨淋巴结(SLN)1~2枚阳性的乳腺癌患者,腋窝非前哨淋巴结(nSLN)转移的危险因素,预测nSLN转移风险。方法选择2002—2017年手术治疗的、SLN 1~2枚阳性的乳腺癌患者917例,收集其临床病理资料。根据手术时间将患者分为建模组(497例)和验证组(420例)。以nSLN是否转移为因变量,建立列线图模型,并对模型的预测效果进行验证。结果917例患者的nSLN转移率为27.4%。单因素分析显示,病理分级、原发肿瘤脉管瘤栓、淋巴结包膜外受侵、SLN阳性数、SLN阴性数、SLN是否宏转移与乳腺癌患者腋窝nSLN转移有关(均P<0.05)。多因素Logistic回归分析显示,SLN阳性数、SLN阴性数和SLN是否宏转移为乳腺癌患者腋窝nSLN转移的独立影响因素(均P<0.05)。以有统计学意义的变量,建立了列线图模型。建模组预测nSLN转移风险的受试者工作特征(ROC)曲线下面积为0.718,验证组预测nSLN转移风险的ROC曲线下面积为0.742。结论利用6个危险因素建立的nSLN转移风险预测模型有较高的准确性,可能有助于临床医师进行临床决策。
Objective To identify the risk factors of non-sentinel lymph node(nSLN)metastasis in breast cancer patients with 1~2 positive axillary sentinel lymph node(SLN)and construct an accurate prediction model.Methods Retrospective chart review was performed in 917 breast cancer patients who underwent surgery treatment between 2002 and 2017 and pathologically confirmed 1-2 positive SLNs.According to the date of surgery,patients were divided into training group(497 cases)and validation group(420 cases).A nomogram was built to predict nSLN metastasis and the accuracy of the model was validated.Results Among the 917 patients,251(27.4%)had nSLN metastasis.Univariate analysis showed tumor grade,lymphovascular invasion(LVI),extra-capsular extension(ECE),the number of positive and negative SLN and macro-metastasis of SLN were associated with nSLN metastasis(all P<0.05).Multivariate Logistic regression analysis showed the numbers of positive SLN,negative SLN and macro-metastasis of SLN were independent predictors of nSLN metastasis(all P<0.05).A nomogram was constructed based on the 6 factors.The area under the receiver operating characteristic curve was 0.718 for the training group and 0.742 for the validation group.Conclusion We have developed a nomogram that uses 6 risk factors commonly available to accurately estimate the likelihood of nSLN metastasis for individual patient,which might be helpful for radiation oncologists to make a decision on regional nodal irradiation.
作者
杨颛搏
黄州
王淑莲
唐玉
景灏
王健仰
张江鹄
杨勇
宋永文
房辉
金晶
刘跃平
亓姝楠
李宁
唐源
卢宁宁
陈波
王翔
高纪东
王靖
宣立学
方仪
李晔雄
Yang Zhuanbo;Huang Zhou;Wang Shulian;Tang Yu;Jing Hao;Wang Jianyang;Zhang Jianghu;Yang Yong;Song Yongwen;Fang Hui;Jin Jing;Liu Yueping;Qi Shunan;Li Ning;Tang Yuan;Lu Ningning;Chen Bo;Wang Xiang;Gao Jidong;Wang Jing;Xuan Lixue;Fang Yi;Li Yexiong(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Breast Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2020年第8期653-659,共7页
Chinese Journal of Oncology
基金
国家重点研发计划项目(2016YFC0904600)
首都临床特色应用研究(Z171100001017116)。
关键词
乳腺肿瘤
前哨淋巴结
非前哨淋巴结
淋巴结转移
列线图
预测模型
Breast neoplasms
Sentinel lymph node
Non-sentinel lymph node
Lymph node metastasis
Nomogram
Prediction Model
