摘要
背景与目的:近年来,乳腺癌的发病人群趋于年轻化,并且更容易发生腋窝淋巴结(ALN)转移。本研究通过临床病理大数据平台分析年轻乳腺癌患者ALN转移的影响因素,并建立风险预测模型,为年轻乳腺癌患者的诊断和治疗提供参考依据。方法:收集SEER数据库中2010—2015年间被诊断为乳腺癌并且接受了ALN手术的年轻患者的临床病理资料,采用单因素和多因素回归分析筛选ALN转移的影响因素,并以列线图的方式可视化。通过AUC/C指数量化列线图区分不同ALN状态患者的能力,采用bootstrap方法(1000次重复,随机数种子设置为12)进行列线图预测性能内部验证。另外,收集2015—2017年在武汉大学中南医院初诊为乳腺癌的年轻患者资料,对模型行外部验证。结果:共纳入SEER数据库中23778例年轻乳腺癌患者,其中39.6%患者存在ALN转移。单因素Logistic回归分析显示,年龄、种族、肿瘤部位、病理学分级、肿瘤大小、胸壁或皮肤是否受侵以及ER、PR、HER-2状态与ALN转移有关(均P<0.001);多因素Logistic回归分析显示:年龄、种族、婚姻状态、边侧、肿瘤部位、分级、肿瘤大小、胸壁或皮肤是否受侵以及ER与PR状态是ALN转移独立影响因素(均P<0.05),据此建立风险预测模型。内部验证的校准曲线显示,利用该模型计算的预测值与真实值之间存在良好的一致性(AUC/C指数=0.716)。共纳入391例年轻乳腺癌患者作为外部验证数据集,其中49.9%患者初次手术发现有ALN转移。外部验证提示模型预测能力较好(AUC/C指数=0.798)。结论:基于SEER数据库建立的年轻乳腺癌患者ALN转移的风险预测模型具有较好的预测能力,可为临床预测患者ALN转移风险提供参考。
Background and Aims:Over the recent years,the incidence of breast cancer is increasingly shifting to younger population,which is more likely to develop axillary lymph node(ALN)metastasis.Therefore,this study was conducted to determine the influencing factors for ALN metastasis in young breast cancer patients using big-data platform of clinicopathologic information and establish a risk prediction models,so as to provide a reference for the clinical diagnosis and treatment of breast cancer in young adults.Methods:The clinicopathologic data of young patients who were diagnosed with breast cancer and underwent ALN dissection between 2010 and 2015 were selected from the SEER database.The influencing factors for ALN metastasis were determined by univariate and multivariate analysis,and were subsequently visualized by nomogram.The ability of the nomogram to identify patients with different ALN status was quantized using the AUC/C-index.The internal verification of the prediction performance of the nomogram was estimated by bootstrap method(1000 replicates with a random seed of 12).Furthermore,the data of young patients with newly diagnosed breast cancer from 2015 to 2017 in Zhongnan Hospital of Wuhan University were collected for external validation of the original model.Results:A total of 23778 young patients with breast cancer was recruited from the SEER database,39.6%of whom had ALN metastasis.Univariate Logistic regression analysis showed that age,race,location of primary tumor,pathological grade,tumor size,and presence or absence of the chest wall or skin invasion as well as the status of ER,PR and HER-2 were significantly associated with ALN metastasis(all P<0.001).Multivariate Logistic regression analysis showed that age,race,and marital status,laterality,location of primary tumor and grade,tumor size,and presence or absence of the chest wall or skin invasion as well as the status of the ER,PR were independent influencing factors for ALN metastasis(all P<0.05),based on which,the risk prediction model was establis
作者
宋文静
贺鑫
龚鹏举
杨燕
魏蕾
张京伟
SONG Wenjing;HE Xin;GONG Pengju;YANG Yan;WEI Lei;ZHANG Jingwei(Department of Breast and Thyroid Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,China;Department of Pathology and Pathophysiology,School of Basic Medical Sciences,Wuhan University,Wuhan 430071,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第11期1293-1302,共10页
China Journal of General Surgery
关键词
乳腺肿瘤
青年人
淋巴转移
危险因素
大数据
Breast Neoplasms
Young Adult
Lymphatic Metastasis
Risk Factors
RBig Data
