乳腺癌新辅助化疗后同侧锁骨上淋巴结病理完全缓解列线图预测模型的构建  

Construction of a nomogram prediction model for pathological complete response(pCR)of ipsilateral supraclavicular lymph node after neoadjuvant chemotherapy for breast cancer with first diagnosis of ipsilateral supraclavicular lymph node metastasis

作　　者：吕民豪 焦得闯 吴军召 田沛琦 马有钊 刘真真 陈秀春 Lyu Minhao;Jiao Dechuang;Wu Junzhao;Tian Peiqi;Ma Youzhao;Liu Zhenzhen;Chen Xiuchun(Department of Breast Surgery,Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)乳腺外科,郑州450008

出　　处：《中华肿瘤杂志》2022年第2期160-166,共7页Chinese Journal of Oncology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210188)。

摘　　要：目的建立乳腺癌新辅助化疗后同侧锁骨上淋巴结病理完全缓解(ispCR)的预测模型, 以指导局部治疗。方法连续纳入2012年9月至2019年5月河南省肿瘤医院收治的首诊同侧锁骨上淋巴结转移且新辅助化疗后行同侧锁骨上淋巴结清扫的乳腺癌患者211例, 分为训练集142例, 验证集69例。采用单因素和多因素logistic回归分析确定乳腺癌新辅助化疗后ispCR的影响因素, 建立乳腺癌新辅助化疗后ispCR的列线图预测模型。通过受试者工作特征(ROC)曲线分析和绘制校准曲线对列线图预测模型进行内部和外部验证评价。结果单因素logistic回归分析显示, Ki-67指数、腋窝淋巴结转移数目、乳腺pCR、腋窝pCR、新辅助化疗后同侧锁骨上淋巴结大小与乳腺癌新辅助化疗后ispCR有关(均P<0.05)。多因素logistic回归分析显示, 腋窝淋巴结转移数目(OR=5.035, 95%CI为1.722~14.721)、乳腺pCR (OR=4.662, 95%CI为1.456~14.922)和新辅助化疗后同侧锁骨上淋巴结大小(OR=4.231, 95%CI为1.194~14.985)是乳腺癌新辅助化疗后ispCR的独立影响因素。根据乳腺癌新辅助化疗后ispCR的最佳logistic回归模型, 基于腋窝淋巴结转移数目、乳腺pCR、新辅助化疗后同侧锁骨上淋巴结的大小、腋窝pCR、Ki-67指数这5个因素, 构建乳腺癌新辅助化疗后ispCR的列线图预测模型。预测模型在训练集和验证集中ROC曲线下的面积分别为0.855和0.838, 二者之间差异无统计学意义(P=0.755)。新辅助化疗后ispCR组和非ispCR组患者的3年无病生存率分别为64.3%和54.8%, 差异有统计学意义(P=0.024);3年总生存率分别为83.8%和70.2%, 差异无统计学意义(P=0.087)。结论新辅助化疗后ispCR的乳腺癌患者无病生存明显改善。所构建的乳腺癌患者新辅助化疗后ispCR列线图预测模型拟合良好, 利用该预测模型可以辅助制定乳腺癌新辅助化疗后同侧锁骨上区的局部处理策略, 并预测患者的远期预Objective To develop a predictive model for pathologic complete response(pCR)of ipsilateral supraclavicular lymph nodes(ISLN)after neoadjuvant chemotherapy for breast cancer and guide the local treatment.Methods Two hundred and eleven consecutive breast cancer patients with first diagnosis of ipsilateral supraclavicular lymph node metastasis who underwent ipsilateral supraclavicular lymph node dissection and treated in the Breast Department of Henan Cancer Hospital from September 2012 to May 2019 were included.One hundred and forty two cases were divided into the training set while other 69 cases into the validation set.The factors affecting ipsilateral supraclavicular lymph node pCR(ispCR)of breast cancer after neoadjuvant chemotherapy were analyzed by univariate and multivariate logistic regression analyses,and a nomogram prediction model of ispCR was established.Internal and external validation evaluation of the nomogram prediction model were conducted by receiver operating characteristic(ROC)curve analysis and plotting calibration curves.Results Univariate logistic regression analysis showed that Ki-67 index,number of axillary lymph node metastases,breast pCR,axillary pCR,and ISLN size after neoadjuvant chemotherapy were associated with ispCR of breast cancerafter neoadjuvant chemotherapy(P<0.05).Multivariate logistic regression analysis showed that the number of axillary lymph node metastases(OR=5.035,95%CI:1.722-14.721,P=0.003),breast pCR(OR=4.662,95%CI:1.456-14.922,P=0.010)and ISLN size after neoadjuvant chemotherapy(OR=4.231,95%CI:1.194-14.985,P=0.025)were independent predictors of ispCR of breast cancer after neoadjuvant chemotherapy.A nomogram prediction model of ispCR of breast cancer after neoadjuvant chemotherapy was constructed using five factors:number of axillary lymph node metastases,Ki-67 index,breast pCR,axillary pCR and size of ISLN after neoadjuvant chemotherapy.The areas under the ROC curve for the nomogram prediction model in the training and validation sets were 0.855 and 0.838,respectivel

关 键 词：乳腺肿瘤 新辅助化疗 同侧锁骨上淋巴结转移 病理完全缓解 列线图预测模型 预后 

分 类 号：R737.9[医药卫生—肿瘤]