早期乳腺癌腋窝淋巴结转移风险因素及风险预测模型的建立  

Risk Factors and Establishing Predictive Risk-scoring Model for Axillary Lymph Node Metastasis in Early Breast Cancer

作　　者：韦军 王聪[1] 谢贤鑫 李伟杰 姜大庆[1] WEI Jun;WANG Cong;XIE Xian-xin;LI Wei-jie;JIANG Da-qing(Department of Breast Surgery,Liaoning Cancer Hospital/Cancer Hospital of China Medical University,Shenyang,Liaoning,110042,China)

机构地区：[1]辽宁省肿瘤医院/中国医科大学肿瘤医院乳腺外科,辽宁沈阳110042

出　　处：《现代生物医学进展》2019年第4期684-689,共6页Progress in Modern Biomedicine

基　　金：辽宁省科技攻关项目(2014215071)

摘　　要：目的:探究早期乳腺癌腋窝淋巴结转移的独立危险因素,并建立有效的风险预测模型。方法:回顾性分析辽宁省肿瘤医院2016年6月至2017年12月收治的404例早期乳腺癌患者的临床资料,采用x2检验或Fisher确切概率法对临床病理特征与腋窝淋巴结转移情况进行单因素分析,采用多元逐步Logistic回归分析探索腋窝淋巴结转移的独立危险因素,根据各危险因素的回归系数进行赋值,建立风险预测模型,采用ROC曲线验证其检验效能并绘制校准曲线评估其与真实情况的一致性。结果:早期乳腺癌发生腋窝淋巴结转移与肿瘤大小、病理分级、脉管侵袭、ER表达、KI67大小、分子亚型和淋巴结总数≥14枚(14枚为淋巴结平均数)之间存在统计学差异(P<0.05),而与年龄、绝经与否、肿瘤位置、病理类型、PR等因素无关(P>0.05)。单因素及多因素分析结果显示肿瘤>2 cm、病理分级Ⅲ级、存在脉管侵袭及ER表达≧50%是早期乳腺癌发生腋窝淋巴结转移的独立危险因素(P<0.05)。风险预测模型ROC曲线下面积为0.852(95%CI为(0.812,0.892),P<0.01)。校准曲线R2=0.9086(P<0.05)。结论:肿瘤>2 cm、病理分级Ⅲ级、存在脉管侵袭、ER表达≧50%早期乳腺癌患者发生腋窝淋巴结转移风险较高。Objective: To explore the independent risk factors of axillary lymph node metastasis in early breast cancer and establishing an effective risk prediction model. Methods: The clinical data of 404 early breast cancer patients from June 2016 to December2017 in Liaoning Cancer Hospital were enrolled in this study. The chi-square test or Fisher’s exact test were used to analyze the clinical pathological characteristics and axillary lymph node metastasis. Multivariate stepwise logistic regression analysis was used to explore the independent risk factors of axillary lymph node metastasis. Risk prediction model was established according to the regression coefficients of each risk factor. ROC curve was used to verify the effectiveness of the test and calibration curve was drawn to evaluate its consistency with the real situation. Results: Axillary lymph node metastasis in early breast cancer was significantly different(P<0.05) between tumor size, pathological grade, vascular invasion, ER expression, size of KI67, molecular subtype and total number of lymph nodes ≥14(14 were the average number of lymph nodes), but not related to age, menopause, tumor location, pathological type, PR and other factors(P>0.05). Univariate and multivariate analysis showed that tumor > 2 cm, pathological grade Ⅲ, vascular invasion and ER expression≧50% were independent risk factors for axillary lymph node metastasis in early breast cancer(P<0.05). The area under the ROC curve was0.852(95% CI was(0.812, 0.892), P<0.01). The calibration curve R^2=0.9086(P<0.05). Conclusion: Tumor>2 cm, pathological grade Ⅲ,vascular invasion, and ER≧50% are independent risk factors for axillary lymph node metastasis in early breast cancer.

关 键 词：早期乳腺癌 腋窝淋巴结转移 风险因素 模型 

分 类 号：R737.9[医药卫生—肿瘤]