基于TGF-β和PDGF对乳腺癌非前哨淋巴结转移的Nomogram预测模型的构建及评价  

Development and Assessment of a Nomogram Based on TGF-β and PDGF for Predicting Non-Sentinel Lymph Node Metastasis of Breast Cancer

作　　者：张琳 王桂春 尹萍 宋阳 路中[2] Zhang Lin;Wang Guichun;Yin Ping;Song Yang;Lu Zhong(Clinical Medical College,Weifang Medical College,Weifang 261053,China;Department of Oncology,The Affiliated Hospital of Weifang Medical College,Weifang 261042,China)

机构地区：[1]潍坊医学院临床医学院,山东潍坊261053 [2]潍坊医学院附属医院肿瘤科,山东潍坊261042

出　　处：《南开大学学报（自然科学版）》2022年第1期71-77,共7页Acta Scientiarum Naturalium Universitatis Nankaiensis

摘　　要：前哨淋巴结(SLN)活检是评估乳腺癌患者腋窝淋巴结状态的重要手段.如果能从SLN阳性患者中筛选出非前哨淋巴结(NSLN)转移低危人群,则可避免不必要的腋窝清除,因此采用非手术方法判断SLN阳性患者NSLN的状态十分重要.本研究通过分析SLN阳性的乳腺癌患者发生NSLN转移与转化生长因子-β(TGF-β)和血小板源生长因子(PDGF)以及相关临床病理特征的关系,成功构建列线图预测模型.单因素分析结果显示:SLN阳性患者发生NSLN转移与肿瘤大小、脉管癌栓、SLN阳性个数、SLN阳性比例、TGF-β表达和PDGF表达相关,差异有统计学差异(P<0.05).多因素结果显示:有脉管癌栓、SLN阳性个数>2、SLN阳性比例>0.5、TGF-β>34.14 ng/mL、PDGF>390.55 pg/mL是SLN阳性乳腺癌患者NSLN转移的独立危险因素.根据多因素分析结果建立列阵图预测模型,内部验证的C-index值为0.825,说明该模型具有较好预测效果.ROC曲线下的面积为AUC为0.872,说明该模型具有较好的区分度.校准曲线显示预测曲线与理想曲线贴合较好.决策曲线显示该模型具有较好的临床实用性.总之以脉管癌栓、SLN阳性个数、SLN阳性比例、TGF-β表达、PDGF表达建立的列线图预测模型可以为临床治疗提供参考依据.Sentinel lymph node(SLN)biopsy is an important means to evaluate axillary lymph node status in breast cancer patients.How to screen the low-risk population of none sentinel lymph node(NSLN)metastasis from SLN positive patients can avoid unnecessary axillary clearance.Therefore,it is very important to use non-surgical methods to judge the status of nsln in SLN positive patients.To explore the potential role of transforming growth factor-beta(TGF-β)and platelet-derived growth factor(PDGF)combined with clinicopathological characteristics in predicting non-sentinel lymph node(NSLN)metastasis of breast cancer patients with positive sentinel lymph node(SLN),and establish nomogram predictive models based on results.Univariate analysis showed that NSLN metastasis in breast cancer patients with positive SLN was significantly associated with tumour size,vascular tumor thrombus,number of positive SLN,SLN positive ratio,the level of TGF-βand the level of PDGF.The difference was statistically significant(P<0.05).Multivariate analysis showed that vascular tumor thrombus,number of positive SLN>2,SLN positive ratio>0.5,TGF-β>34.14 ng/mL and PDGF>390.55 pg/mL were independent factors for NSLN metastasis.The prediction model was established according of the results of multivariate analysis.The C-index value is 0.825,which showed that the model has good prediction effect.

关 键 词：乳腺癌 非前哨淋巴结 转化生长因子-β 血小板源生长因子 列线图 

分 类 号：R73[医药卫生—肿瘤]