乳腺癌非前哨淋巴结转移相关因素及其列线图验证性研究  

Risk factors for non-sentinel lymph node metastasis and validation study of the MSKCC nomogram in patients with breast cancer

作　　者：邱鹏飞[1] 刘娟娟[2] 王永胜[1] 刘雁冰[1] 李永清[1] 周正波[1] 陈鹏[1] 赵桐[1] 孙晓[1] 王春建[1] 张朝蓬[1] 刘广[1] 

机构地区：[1]山东省肿瘤医院乳腺病中心,山东济南250117 [2]山东省肿瘤医院核医学科,山东济南250117

出　　处：《中国实用外科杂志》2012年第11期945-949,共5页Chinese Journal of Practical Surgery

基　　金：山东省科学技术发展计划项目(2009GG10002019);山东省医药卫生科技发展计划项目重点项目(2011HD012)

摘　　要：目的探索乳腺癌非前哨淋巴结(NSLN)转移的危险因素,验证纪念斯隆凯特琳癌症中心(MSKCC)列线图的临床应用价值。方法回顾性分析山东省肿瘤医院2001年12月至2012年1月接受前哨淋巴结活检的1227例乳腺癌病人,评估前哨淋巴结(SLN)阳性病人NSLN转移的危险因素。登陆MSKCC网站计算病人NSLN转移风险,通过绘制趋势线和计算受试者工作特征曲线(ROC)下面积(AUC)评估预测准确性。结果肿瘤大小、SLN阳性数、组织学分级、脉管侵犯和多灶性与NSLN转移差异有统计学意义(P<0.05),其中肿瘤大小、SLN阳性数、组织学分级和脉管侵犯是NSLN转移的独立预测因素。趋势线显示预测值曲线和真实值曲线趋势基本相同,MSKCC列线图的AUC值为0.765,预测值<10%的病人(51/412,12.4%)NSLN阳性率为5.9%(3/51)。结论 MSKCC列线图可以较准确的预测NSLN转移风险,为病人是否行腋窝淋巴结清扫术(ALND)提供参考依据,预测值<10%的病人可以避免ALND。Objective To evaluate the risk factors for non-sentinel lymph node （NSLN） metastasis, and validate the value of the Memorial Sloan Kettering Cancer Center （MSKCC） nomogram for the prediction of NSLN metastasis in patients with breast cancer. Methods A sentinel lymph node biopsy （SLNB） database containing 1227 consecutive breast cancer patients admitted between December 2001 and January 2012 in Shandong Cancer Hospital was analyzed retrospectively. The patients with positive sentinel lymph node （SLN） should be evaluated for risk factors of NSLN metastasis. MSKCC nomogram was used to estimate probability of NSLN involvement, and the predictive accuracy was assessed by calculating the trend line and the area under the receiver-operator characteristic （ROC） curve. Results Tumor size, number of positive SLN, nuclear grade, lymphovascular invasion and muhifocality correlated with NSLN metastasis （all P〈0.05）. Only tumor size （P=0.001）, number of positive SLN （P=0.000）, nuclear grade （P=0.008） and lymphovascular invasion （P=0.001） were significant independent predictors for the NSLN metastasis. The trend of actual probability in various decile groups was comparable to the predicted probability. The MSKCC nomogram presented a ROC value of 0.765. Patients with predictive values lower than 10% （51/412,12.4%） have a frequency of NSLN metastasis of 5.9% （3/51 ）. Conclusion The MSKCC nomogram can provide an accurate prediction of the probability of NSLN metastasis, and give a reference basis about the axillary lymph node dissection （ALND）. ALND could be avoided in patients with the predictive values lower than 10%.

关 键 词：乳腺癌 前哨淋巴结 非前哨淋巴结 MSKCC列线图 

分 类 号：R6[医药卫生—外科学]