MSKCC乳腺癌前哨淋巴结转移预测模型的验证性研究  

Validation of MSKCC nomogram in predicting sentinel lymph node metastasis of breast cancer

作　　者：陈嘉莹[1,2] 陈嘉健[1,2] 杨犇龙[1,2] 刘哲斌 黄晓燕[1,2] 柳光宇[1,2] 韩企夏[1,2] 杨文涛[1,3] 沈镇宙[1,2] 邵志敏[1,2] 吴炅[1,4] 

机构地区：[1]复旦大学上海医学院肿瘤学系 [2]复旦大学附属肿瘤医院乳腺外科,上海200032 [3]复旦大学附属肿瘤医院病理科,上海200032 [4]复旦大学附属肿瘤医院,上海200032

出　　处：《中国实用外科杂志》2011年第1期89-93,共5页Chinese Journal of Practical Surgery

基　　金：上海市科委科研基金(No.54119524);上海市教委曙光计划(No.05SG04)资助

摘　　要：目的验证并评估美国纪念斯隆-凯特琳癌症中心(MSKCC)前哨淋巴结转移预测模型在中国早期乳腺癌病人中的临床应用价值。方法回顾性分析复旦大学附属肿瘤医院乳腺外科2005年3月至2009年10月接受前哨淋巴结活检的524例乳腺癌病人的病历资料,探索前哨淋巴结转移相关的临床病理因素。利用MSKCC淋巴结转移预测模型计算每例病人前哨淋巴结转移风险,并以校正曲线和受试者操作特性曲线(ROC曲线)下面积(AUC)评估该模型在中国早期乳腺癌病人中的临床应用价值。结果发病年龄、肿瘤原发灶大小、肿瘤组织学分级、神经侵犯、脉管侵犯情况等因素与前哨淋巴结转移有关。其中,原发灶大小(OR1.429,95%CI1.142-1.788)和脉管情况(OR9.462,CI5.551-16.130)是独立的危险因素。校正曲线显示预测值曲线和真实值曲线趋势相同,MSKCC模型的AUC为0.757。结论 MSKCC淋巴结转移预测模型可较准确地应用于中国人群,作为术前评估工具具有较好的临床应用价值。Objective To validate the clinical value of the MSKCC nomogram that predicts the presence of sentinel lymph node （SLN） metastasis in Chinese early-stage breast cancer population. Methods Data were collected from 524 patients with successful SLN biopsy who were treated during 2005 March to 2009 October. Touch imprint cytology （TIC） and serial section with H＆E staining were performed routinely on each sentinel node. MSKCC nomogram was used to estimate probability of SLN involvement and compared with actual probability after grouping into deciles. A ROC curve was drawn and predictive accuracy was assessed by calculating the area under the receiver-operating characteristic （ROC） curve. Results It was shown that age, tumor size, histological grade and lymphovascular invasion was correlated with the probability of SLN metastasis by univariate analysis. By Multivariate analysis, tumor size and lymphovascular invasion were identified as independent predictors of SLN metastasis. The odds ratio（OR ）of the iymphovascular invasion was 9.462 （95% CI 5.551-16.130） while OR of tumor size was 1.429 （95% CI 1.142-1.788）. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.757 as compared to 0.754 in the original population. Conclusion The MSKCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed good in a Chinese breast cancer population. It could provide a clinical accessory in the preoperative discussion of the patients.

关 键 词：MSKCC模型 前哨淋巴结 淋巴结转移 预测 乳腺癌 

分 类 号：R6[医药卫生—外科学]