乳腺导管内癌微浸润的危险因素分析  

作　　者：罗华[1] 杨欧欧[1] 何俊玲[1] 蓝天[1] 胡祖健[1] 

机构地区：[1]杭州市中医院,310007

出　　处：《浙江临床医学》2021年第5期687-689,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析乳腺导管内癌(DCIS)患者发生微浸润(DCISM)的危险因素。方法回顾性分析2008年1月至2016年12月221例DCIS和DCISM患者的临床资料。采用Logistic回归筛选出可能预测DCISM的临床、影像学和组织病理学的危险因素,根据独立危险因素建立预测导管内癌发生微浸润的列线图模型。结果多因素Logistic回归分析显示,DCIS病灶(肿瘤直径≥2 cm)、可触及肿块、乳房钼靶X线提示钙化和/或肿块、高级别核分级与DCISM显著相关。利用这些因素绘制列线图显示良好的预测性能(受试者工作特征曲线下面积0.811,95%CI0.752~0.870)。在校准图形中标准曲线与预测校准曲线拟合良好,表明模型-致性较好。结论基于四个危险因素的列线图能准确预测导管内癌微浸润,该模型对导管内癌患者临床治疗选择有指导意义。Objective To identify risk factors for breast ductal carcinoma in situ with microinvasion(DCISM)in patients diagnosed with ductal carcinoma in situ(DCIS).These factors were used to establish a nomogram for predicting the risk of microinvasion in the preoperative setting.Methods A retrospective analysis was performed of 221 patients with an initial diagnosis of DCIS and DCISM between January 2008 and December 2016.The independent risk factors were determined by Logistic regression analysis,and identify clinical,radiological and histopathological factors that may predict DCISM.A nomogram was developed to predict the probability of microinvasion using multiple logistic regression analysis by using R software.Results Multivariate Logistic regression analysis revealed that a larger DCIS lesion(tumor size greater than 2cm),palpable tumor,mammographic calcifications and/or with mass,high nuclear grade,were significantly associated with DCISM.A nomogram developed using these factors demonstrated good predictive performance(area under the receiver operating characteristic(ROC)curve(AUC)0.811,95 percent confidence interval 0.752 to 0.870).In the calibration graph,the standard curve was properly fit with the predicting calibration curve,suggested that the model consistency was fine.Conclusion A nomogram based on the four most significant factors related to accurately predicted microinvasion cancer.This nomogram may be useful for guiding clinical treatment in patients with DCIS.

关 键 词：导管内癌 导管内癌伴微浸润 列线图 风险因素 

分 类 号：R73[医药卫生—肿瘤]