早期乳腺癌脑转移预测模型的建立和分析  

Establish and analyze the predictive model of early stage brain metastases in patients with breast cancer

作　　者：王秋生[1] 吴世凯[1] 孙冰[1] 黄州 孟祥颖[1] 黄焰[2] 

机构地区：[1]安徽医科大学解放军307临床学院军事医学科学院附属医院放疗科,北京100071 [2]安徽医科大学解放军307临床学院军事医学科学院附属医院乳腺外科,北京100071

出　　处：《中华医学杂志》2015年第48期3927-3929,共3页National Medical Journal of China

摘　　要：目的 探讨早期乳腺癌术后脑转移的危险因素,为早期诊治脑转移提供指导.方法 采集了2005至2009年间术后乳腺癌患者的疾病资料,对发生和没发生脑转移的两组患者进行了logistic回归统计分析,并建立了数学模型探讨影响脑转移发生的危险因素.结果 共824例早期术后乳腺癌患者入组,中位随访68个月,其中199例发生了脑转移.统计分析结果显示：年龄＜35岁、绝经前期、肿瘤组织分级高、临床分期Ⅲ期、人表皮生长因子受体2（HER-2）（＋）和雌激素受体（ER）（-）是脑转移的危险因素.进一步建立数学模型预测脑转移发生概率,以预测概率数值为检验变量,脑转移状况为状态变量,绘制ROC曲线,曲线下面积（AUC）为0.743±0.018,敏感性和特异性都较高,标志该模型预测能力中等.结论 初诊年龄＜ 35岁、绝经前期、组织分级高、临床分期晚,ER（-）和HER-2阳性是脑转移发生的独立危险因素,建立的脑转移预测模型对乳腺癌脑转移具有预测价值.Objective To investigate the risk factors of cerebral metastasis of breast cancer and to provide guidance for the early diagnosis and treatment of brain metastases.Methods Clinical data of postoperative patients with breast cancer were collected in our hospital from 2005 to 2009.All the patients were divided into two groups,with or without brain metastasis.The risk factors of brain metastases of patients with breast cancer were analyzed by the logistic regression.Results Eight hundred and twenty four early postoperative patients with breast cancer were enrolled.The median follow-up time was 68 months and 199 cases had brain metastasis.The univariate logistic regression results showed that higher grade of tumor,〈 35 years,premenopausal,clinical stage Ⅲ,HER-2 positive and ER negative,no adjuvant chemotherapy,no adjuvant normal therapy were the risk factors of brain metastasis.The multivariate logistic regression result showed that higher grade of tumor,〈 35 years,premenopausal,clinical stage Ⅲ,HER-2 positive,ER negative were the risk factors.The mathematical model was used to predict the probability of occurrence of brain metastasis.ROC curve were draw by the value of predict probability as test variable and the brain metastasis status as state variables.The AUC value of this predictive model was 0.743 ±0.018.The specificity and sensitivity are relative high.Conclusion Age 〈 35 years,premenopausal,clinical stage Ⅲ,HER-2 positive and ER negative were independent risk factors for brain metastases.This model has the predictive value for the occurrence of brain metastases from breast cancer.

关 键 词：乳腺肿瘤 危险因素 脑转移 预测模型 

分 类 号：R737.9[医药卫生—肿瘤]