乳腺恶性叶状肿瘤预后因素分析及预后预测模型的构建  

Prognostic factor analysis and prognostic nomogram of malignant breast phyllodes tumors

作　　者：刘泰源 李珺[1] 高济越 赵海东[1] Liu Taiyuan;Li Jun;Gao Jiyue;Zhao Haidong(Department of Breast Surgery,Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连医科大学附属第二医院乳腺外科,116023

出　　处：《中华乳腺病杂志（电子版）》2022年第6期346-352,共7页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨乳腺恶性叶状肿瘤(MPTB)的预后影响因素,并建立预后预测模型。方法根据纳入排除标准检索并筛选美国国立癌症研究所建立的监测、流行病学、随访结果数据库(SEER)中1 363例MPTB患者数据,采用Kaplan-Meier法计算MPTB患者的肿瘤特异性生存(CSS),各临床病理因素对CSS的影响比较采用Log-rank检验进行单因素分析。将单因素分析有意义的变量引入Cox比例风险回归模型进行MPTB患者预后多因素分析,建立Nomogram预后预测模型并使用C-指数与校正曲线验证其预测准确性。结果(1)1 363例MPTB患者术后1、2、5、10年的CSS率分别为97%(1 322/1 363)、94%(1 285/1 363)、91%(1 250/1 363)和89%(1234/1 363)。(2)单因素生存分析结果显示:年龄、肿瘤直径、肿瘤分期、婚姻状态和区域淋巴结状态和MPTB患者CSS有关(χ^(2)=55.135、120.215、249.650 、5.230、215.208,P均<0.050)。(3)多因素分析结果显示年龄(>45岁且<68岁和≥68岁分别与≤45岁比较:HR=2.490,95%CI:1.466~4.229,P=0.001;HR=5.296,95%CI:2.890~9.704,P<0.001)、肿瘤直径(>59 mm且<115 mm和≥115 mm分别与≤59 mm比较:HR=2.187,95%CI:1.421~3.366,P=0.002;HR=3.846,95%CI:2.395~6.174,P<0.001)、肿瘤分期(区域和远处转移分别和局部比较:HR=2.353,95%CI:1.409~3.929,P=0.001;HR=10.195,95%CI:5.187~20.038,P<0.001)和区域淋巴结阳性(HR=4.830,95%CI:1.883~12.387,P=0.001)均是MPTB患者预后的独立影响因素。(4)利用年龄、肿瘤直径、肿瘤分期和区域淋巴结状态这4个变量建立了Nomogram预后预测模型,该模型的C指数=0.82,并且通过校正曲线证明了模型具有良好的预测能力。结论高龄、大肿瘤、局部进展及转移的MPTB患者预后不佳,早期发现和早期治疗对MPTB患者非常重要。Objective To investigate the prognostic factors in patients with malignant phyllodes tumors of the breast (MPTB), and establish a predictive nomogram.Methods In accordance with the inclusive and exclusive criteria, the data of 1 363 patients diagnosed with MPTB in the Surveillance, Epidemiology and Results (SEER) database of the U. S. National Cancer Institute were analyzed in this study. The Kaplan-Meier survival analyses were performed to evaluate the cause-specific survival (CSS) of MPTB patients. The log-rank test was used to explore the relationship between clinicopathological characteristics and CSS. Multivariate analysis by Cox proportional hazards regression model was performed to analyze the prognostic factors from the variables with a significant difference in univariate analysis. The nomogram was developed to predict the CSS of the MPTB. The C-index and calibration plots were generated to evaluate the accuracy of the nomogram.Results(1) The 1-year, 2-year, 5-year, and 10-year CSS of 1 363 patients were 97%(1322/1 363), 94%(1 285/1 363), 91%(1250/1 363), and 89%(1 234/1 363), respectively. (2) Univariate analysis found that age, tumor size, tumor stage, marital status, and regional lymph node status were related to CSS of MPTB patients(χ^(2)=55.135, 120.215, 249.650, 5.230, 215.208, allP<0.050). (3)Multivariate analysis showed that the independent factors for the prognosis of MPTB patients were as follow: age (≤45 yearsvs45-68 years:HR=2.490, 95%CI: 1.466-4.229,P=0.001;≤45 yearsvs≥68 years:HR=5.296, 95%CI: 2.890-9.704,P<0.001), tumor size(≤59 mmvs59-115 mm:HR=2.187, 95%CI: 1.421-3.366,P=0.002;≤59 mmvs≥115 mm:HR=3.846, 95%CI: 2.395-6.174,P<0.001), tumor stage (localvsregional:HR=2.353, 95%CI: 1.409-3.929,P=0.001;localvsdistant metastasis:HR=10.195, 95%CI: 5.187-20.038,P<0.001) and positive regional lymph node (HR=4.830, 95%CI: 1.883-12.387,P=0.001). (4) The four factors (age, tumor size, tumor stage and regional lymph node status) were used to generate a nomogram predicting the CSS of patien

关 键 词：叶状肿瘤 预后 危险因素 

分 类 号：R73[医药卫生—肿瘤]