亚群治疗效果模式图分析对绝经后乳腺癌内分泌延长治疗指导作用的研究  

Subpopulation treatment effect pattern plot analysis to guide the study of endocrine prolongation therapy for postmenopausal breast cancer

作　　者：彭楠茜 陈波[1] PENG Nanxi;CHEN Bo(Department of Breast Surgery,the First Hospital of China Medical University,Shenyang 110001,Liaoning,China)

机构地区：[1]中国医科大学附属第一医院乳腺外科,沈阳1100010

出　　处：《癌症进展》2021年第5期467-470,共4页Oncology Progress

基　　金：辽宁省教育厅2019年度科学研究项目(ZF20190006)。

摘　　要：目的探讨亚群治疗效果模式图(STEPP)分析对应用5年内分泌治疗的绝经后激素受体(HR)阳性乳腺癌患者远期复发的预测效能。方法选择228例接受内分泌治疗的绝经后HR阳性乳腺癌患者,随访10年,将全部患者按照有无复发分为两组,其中复发组62例,无复发组166例,分析乳腺癌复发的影响因素。以整合临床病理因素的STEPP评分=1.59分为cut-off值,将患者分为高风险组和低风险组,比较两组患者的生存情况。采用受试者工作特征(ROC)曲线评价STEPP分析对乳腺癌复发的预测效能。结果中位随访时间为113.2个月,单因素分析结果表明,肿瘤分级、肿瘤直径、腋窝淋巴结转移数目、Ki-67水平、STEPP评分可能与乳腺癌复发有关(P﹤0.05)。多因素分析结果表明,肿瘤直径、腋窝淋巴结转移、STEPP评分均是乳腺癌患者复发的独立影响因素(P﹤0.05)。高风险组患者的无病生存期(DFS)和总生存期(OS)均短于低风险组。STEPP分析的曲线下面积(AUC)为0.904,灵敏度为82.5%,特异度为87.7%,对乳腺癌远期复发具有良好的预测效能。结论STEPP分析可用于预测绝经后HR阳性乳腺癌患者的远期复发风险,STEPP评分﹥1.59分的患者复发风险较高,建议延长内分泌治疗,改善远期生存。Objective To evaluate the predictive value of subpopulation treatment effect pattern plot(STEPP)analysis for long-term recurrence of postmenopausal hormone receptor(HR)positive breast cancer after 5 years of endocrine therapy.Method 228 postmenopausal patients with HR positive breast cancer who received endocrine therapy were selected.The follow-up period was 10 years.All patients were divided into two groups according to whether recurrence,of which 62 cases were in recurrence group and 166 cases were in non-recurrence group.The influencing factors of recurrence were analyzed.STEPP score 1.59 was used as cut-off value,all patients were divided into high-risk group and lowrisk group,the survival was compared between the two groups.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive efficacy of STEPP analysis.Result The median follow-up time was 113.2 months.Univariate analysis showed that tumor grade,tumor diameter,axillary lymph node metastasis number,Ki-67 level and STEPP score may be associated with recurrence(P<0.05).Multivariate analysis showed that tumor diameter,axillary lymph node metastasis and STEPP score were independent influencing factors for breast cancer recurrence(P<0.05).The disease-free survival(DFS)and overall survival(OS)of the high-risk group were shorter than those of the low-risk group.The area under the curve(AUC)of STEPP was 0.904,the sensitivity was 82.5%,and the specificity was 87.7%,which had a good predictive effect on the long-term recurrence of breast cancer.Conclusion STEPP analysis can be used to predict the long-term recurrence risk of postmenopausal HR positive breast cancer patients.Patients with STEPP score>1.59 have a high risk of recurrence.It is recommended to extend endocrine therapy to improve long-term survival.

关 键 词：乳腺癌 激素受体 内分泌治疗 远期复发 

分 类 号：R737.9[医药卫生—肿瘤]