男性乳腺癌患者预后分析及Nomogram图构建  

Prognostic Nomogram for male breast cancer

作　　者：董良[1] 王伟英[1] 赵建刚[1] 葛丽娜[1] DONG Liang;WANG Wei-ying;ZHAO Jian-gang;GE Li-na(Department of Oncology,China Medical University Shaoxing Hospital,Shaoxing312030,P.R.China)

机构地区：[1]中国医科大学绍兴医院肿瘤内科,浙江绍兴312030

出　　处：《中华肿瘤防治杂志》2020年第11期886-895,共10页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的男性乳腺癌临床罕见,且有明显的异质性,因此,准确评估男性乳腺癌的预后,对指导临床个体化治疗有重要的意义。本研究利用监测、流行病学和结果数据库(The database of the Surveillance,Epidemiology,and End Results Program,SEER数据库)进行男性乳腺癌患者生存预后列线图(Nomogram图)的构建,分析其预测男性乳腺癌预后的能力。方法提取2010-01-01-2015-12-31SEER数据库中2 223例男性乳腺癌患者临床资料。利用倾向性匹配评分(propensity score matching,PSM),将Ⅰ~Ⅲ期患者分为对照组〔雌激素受体(estrogen receptor,ER)阳性,人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)阴性〕和研究组〔ER(+)HER2(+)、ER(-)HER2(+)和ER(-)HER2(-)〕,应用SPSS 24.0统计软件包进行数据分析,采用Cox比例风险回归模型分别比较全组、对照组和研究组患者的预后影响因素,再构建Nomogram图,并分析其对男性乳腺癌预后的预测能力。结果 Cox比例风险回归模型结果表明,组织学分级(P=0.002)、临床病理分期(P<0.001)、T分期(P<0.001)、M分期(P<0.001)、ER状态(P<0.001)和年龄(P<0.001)是全组男性乳腺癌患者的独立预后影响因素。在进一步对Ⅰ~Ⅲ期男性乳腺癌的研究中,年龄(P<0.001)、手术(P<0.001)、T分期(P=0.014)、N分期(P=0.008)、组织学分级(P<0.001)以及化疗(P<0.001)是对照组患者独立预后影响因素,年龄(P=0.084)、手术(P<0.001)、T分期(P=0.003)和化疗(P=0.001)是研究组患者的独立预后影响因素。采用相关因素构建Nomogram图。Nomogram图的内部验证结果表明,3组患者C指数分别为为0.708(95%CI为0.683~0.733)、0.688(95%CI:0.655~0.721)和0.738(95%CI为0.673~0.803);3组的校正曲线均表现出良好的一致性。结论组织学分级、临床病理分期、T分期、M分期、ER表达状态和年龄是男性乳腺癌生存预后的独立指标,基于上述指标建立的Nomogram图模型,可能作为男性乳腺癌预后判�OBJECTIVE Male breast cancer is rare clinically,and it also has obvious heterogeneity.Accurately assessing the prognosis of male breast cancer is very important to guide clinical individual treatment.We developed a Nomogram to predict the overall survival(OS)rate of patients with male breast cancer utilizing the database of the Surveillance,Epidemiology and End Results(SEER)Program.METHODS Obtained the data of 2 223 male breast cancer patients who were diagnosed between 2010.01.01 and 2015.12.31 from the SEER database.By propensity score matching,patients with stageⅠ-Ⅲ were divided into the control group(ER+,HER2-)and the research group(ER+,HER2+,ER-,HER2+,ER-,HER2-).All data were analyzed by using SPSS 24.0 statistical software.The Cox proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic features on OS.Significant prognostic factors were combined to build Nomogram.The predictive performance of Nomogram was evaluated via internal validation by calculating index of concordance(C-index)and plotting calibration curves.RESULTS In all patients,the results of Cox proportional hazards regression model showed that grade(P=0.002),7 th American Joint Committee on Cancer(AJCC)stage(P<0.001),T stage(P<0.001),M stage(P<0.001),ER status(P<0.001)and age at diagnosis(P<0.001)were significantly associated with the survival prognosis.In the control group of stageⅠ-Ⅲ male breast cancer patients,the results of Cox proportional hazards regression model showed that,age at diagnosis(P<0.001),surgery(P<0.001),T stage(P=0.014),N stage(P=0.008),grade(P<0.001)and chemotherapy(P<0.001)were significantly associated with the survival prognosis,while in the research group,age at diagnosis(P=0.084),surgery(P<0.001),T stage(P=0.003)and chemotherapy(P=0.001)were significantly associated with the survival prognosis.These factors were used to establish Nomogram.The Nomograms showed good accuracy in predicting OS rate,with C-index of 0.708(95%CI:0.683-0.733),0.688(95%CI:0.655-0.

关 键 词：乳腺癌 男性 监测、流行病学和结果数据库 临床病理特征 生存分析 Nomogram图 

分 类 号：R737.9[医药卫生—肿瘤]